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o4Ru'N• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />r4�IFd>ti�;e Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />�, <br />Date: <br />Address: <br />City: ; Y <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />I <br />Program Record: 5 <br />Inspection Type: <br />SB180 Posted s No <br />Permit Posted es-, No Re -inspection on or After: <br />- <br />OBSERVATIONS i1K CORRECTIVE ACTIONS <br />vvU <br />— <br />L <br />�r <br />✓ a <br />r0 <br />V <br />B co- <br />�/O • � p,r-Q <br />/ er� <br />t <br />1 Item/Locatic mperature <br />em /Location r <br />Temperature <br />a " .o <br />Name: <br />ertlficetlon Facility Hot Water Temperature <br />Hand Sink: ofChlorine: <br />,erewashIr <br />ppm Heat: <br />'F <br />Exp. Date: <br />arewashing Sink: of <br />Ouat. Amm.: <br />ppm <br />Other: <br />'F <br />By/ Title:/ j <br />Fecelved <br />eclalls.Phone: <br />n: 1 S <br />Time Out: <br />Page of <br />EHD16-24 (2n°pg) 43113 <br />