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SAN JOAQUIN COUNTY <br />P ? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.org/ehd <br />9�)FOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />(�Q— <br />i M777 <br />Date: <br />Address: <br />I <br />City: <br />t ' Zip Code: <br />wner/Operator: <br />a <br />a <br />Telephone: <br />Program Element: <br />Progrim <br />Record: S'� 2`l <br />Inspection Type: ' <br />SB780 Posted <br />No <br />Permit <br />Posted es No <br />Re -Inspection on or After: <br />f <br />OBSERVATIONS AND CORRECTIVE ACTION$ <br />IAI <br />� <br />� <br />u <br />0 <br />I etn/Location . <br />F Temperature. <br />fadd` <br />Name: <br />Na <br />efety Certl}Ica o <br />Facllit Hot Water Tem eratura.�-•'. <br />Hand Sink: P <br />arow <br />Chlorine: m <br />F PP Heat: "F <br />Exp. Date: <br />arewashing Sink: <br />'F <br />Ouat. Amm.: ppm Other: of <br />eoelved By / Title: / <br />IO.. <br />i <br />Ape— A � -� <br />H Specialist: <br />Ime in: If '140 <br />f <br />_ �/ Av <br />_ -r- <br />Phone: <br />Time Out: '� Z Page of <br />1 <br />FOOD r16 GFiAM Gin wn1111VI,iinn <br />EHD 1624 (2n° PA) U&13 <br />