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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />4.... ;a Telephone: (209) 468-3420 Fax. (209) 464-0138 Web: www.sioov.ora/ehd <br />�iFdRN <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: (�IiS <br />J -L <br />Date: <br />Address: <br />City: <br />_Ae <br />L�.r� <br />Zip Code: <br />SLD <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: <br />SB1 BO Posted Yes No <br />Permit Poste Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTION <br />G <br />A If <br />D 5ed <br />prjrL44 J <br />ne <br />Item/Location <br />Temperature <br />Item /LocationML <br />Temperature <br />Footl Safety <br />Name: <br />ication Facility Hot Water Temperature <br />Hand Sink: <br />of <br />Warewashing <br />Chlorine: ppm <br />Heat: <br />of <br />Exp. Date:arewashing <br />Illy Sink: <br />of <br />Ouat. Amm.: <br />ppm <br />ther: <br />of <br />Received By/Title: <br />EH Specialist:v <br />Phone: <br />Time in: <br />Time Out: <br />Page of <br />EHD 16-24 (2w pg) 4IW13 FOOD PROGRAM OR CONTINUATION <br />