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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.orD/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />ddress: 5_S., - 1 ' <br />v� <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element:' <br />Program Record: S .-} -7 <br />Inspection Type: a--. <br />T <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Jtp <br />—7 <br />2-0 2 2CY��Q <br />-ZR-2� <br />-oc tion mperature <br />1 b3ir- <br />1-1 S 1 <br />_ tem / Location-- rature <br />u r <br />Yc <br />3 _ <br />Foo Sate yCuttl <br />N -lHand <br />c Lvc <br />Exp. Date: 2 <br />o lure <br />Sink:•i �p "F Chlorine: <br />ZOO <br />arewashing Sink: ZIO 'F uat. Amm.: <br />arewashin <br />ppm Heat: 'F <br />ppm Other: IF <br />Received By / Title: S. <br />EH Specialist: <br />ime In:Time <br />v �� <br />- <br />Phone: <br />Out: <br />2S <br />Page of <br />cMn PRMPAM NA MNTINIIATION <br />EHD 16-24(2b Pg) 4013 5 0%-'"-------- <br />