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aP4`t''N• SAN JOAQUIN COUNTY <br />a �•£o <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.oro/ehd <br />4CIFd•�N <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: ' ' <br />"3 1 (i .; <br />Date: <br />ddress:I <br />S <br />f'1 City: <br />ll <br />¢ S <br />Zip Code:ID0(� <br />caner/Oper or: <br />cal i ,r n'. 1 A <br />i <br />Telephone: <br />_ <br />Program Element: <br />1 � ( Program Record: I� <br />1 1 ',, <br />Inspection Type: J <br />KOA <br />B180 Posted Yes <br />No Permit Posted a No <br />Re -Inspection on or After: <br />OBS CORRECTIVE ACTIONS <br />ltendLocat% <br />� ` mperature- - <br />"Re / L� <br />0orr <br />Safety Certification <br />nDat, <br />Facility Hot Water Temperature <br />Sink: <br />of hlorine: <br />WarewashingHand <br />ppm Heat: of <br />arewashing Sink: <br />of Vuat. Arrm.: <br />ppm <br />Other: of <br />Received By/ Title: <br />EH Specialist: <br />Phone: <br />(� <br />Time in: <br />Time Out: <br />Pagq of <br />EHD 16-24 (200 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />