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oP° '"• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />dq :ipda�;p Telephone: (209) 468-3420 Fax., (209) 464-0138 Web: www.siaov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: vDate: <br />Address: <br />IF City: <br />Zip Code: <br />s� 6) <br />Owner/Operator: <br />Telephone: <br />Program Element: 6 Program Record: rXb!5q _71-9 <br />7 <br />Inspection Type: <br />(t- <br />6780 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Ar . <br />8 <br />5;a119 <br />F. Hr <br />F rh ,ti `rte LQM <br />au sa,�r <br />3 <br />1) 0- e <br />e¢ z <br />IFL <br />s <br />r <br />lob -c <br />O✓1'I- r � <br />�F <br />ii <br />Item/Location <br />Temperature <br />Item / Location - - <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />;' - <br />Name: <br />Hand Sink: <br />.F <br />Chlorine: PPM <br />Heat: <br />.F <br />Exp. Date: <br />arewashing Sink: <br />.F <br />OuaL Amm.: PPM <br />her: <br />.F <br />Received By/ Title: <br />✓ lz <br />A <br />EH Specialist: ;c— <br />0 Z <br />Phone: <br />Time In: <br />v--% <br />- S ' <br />Time Out: ,®w ; yr S •N� <br />2Pege <br />EHD 16-24 (24 pp) 4WI3 FOOD PROGRAM OR CONTINUA11ON <br />