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SAN .JOAQUIN COUNTY <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4cleeaN4" Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.orra/ehd + <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> NameFacility: City. Zip Code: <br /> Address <br /> : 3 1 <br /> Owner/Operator: lf�c- a }t Telephone: <br /> Program Element: 7 Progra Record: 1 1�CJ Inspection Type: <br /> 1� . _ <br /> Sim 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS. <br /> f <br /> se <br /> r / <br /> 2 IS <br /> n� <br /> 3 Se <br /> e 2 02 <br /> o. - <br /> m/Locatio Temperature ' <br /> Item/Location Temperature <br /> .Food rt CIIhy Hot Water Temperature Warewashirl <br /> tExpDatw.. <br /> Hand Sink: of Chlorine: Ppm Heat: of <br /> arewashing Sink: of Ouat. Amm.: ppm Other: �p <br /> Fcely/Tltle: Le, Cist: Phone:Time Out: Pageof` � '7 <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2n°pg) 413113 <br />