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SAN JOAQUIN COUNTY <br />Q: <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209)464-0138 Web: www.sigov.org/ehd <br />9C%FORS <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: + i .� <br />Date: ` r <br />ddress: C <br />Ci , Zip Code: <br />Owner/Operator: / h .6 <br />- Telephone: <br />Program Element: �•�'. Program Record:. <br />UY 39 <br />/J� • <br />Inspection Type:>5 <br />72 <br />f' /� <br />8180 Posted Yes iY Permit Posted est o <br />IECFV <br />' <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />,r � '�/�.- ,�=rte/G ✓� <br />r %/f <br />y J visv- <br />- <br />"Item/Location_+- - -Temperature- <br />Item 1 Location - ` <br />Temperature <br />Te <br />F. <br />.Food Safety, Certification - <br />Facility Hot Water Temperature _ Warewashing <br />_ <br />Name: r - <br />Hand Sink: <br />"FChlorine: ppm Heat: <br />"F <br />Exp. Date: ). <br />arewashing Sink: <br />'F uat Amm.: ppm Other: <br />'F <br />Received By 1 Title: >� i� V, ' <br />' -. F" / �j <br />EH Specialist: <br />Phone: _ <br />L3 <br />Time in: <br />Time Out: <br />Page of <br />EHD 16-24 (20 pg) 4013 FOOD PROGRAM OIR COWINUATION <br />