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at°�I"• c SAN JOAQUIN COUNTY <br />>. etFd AG <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Far: (209) 464-0138 Web: www.sigov.org/ehd <br />tiFoa <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />5 <br />2 i Z_Date: <br />01—I <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: ippy t-r—I <br />Set 80 Posted s <br />No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />�c <br />L O N ! jD 6 r--toPAk. <br />VkA X <br />To a PERAA= <br />otJCE <br />FG&H SEES/ <br />PA in. <br />_ - <br />item/Location.:. - <br />Temperature <br />I <br />Item / Location <br />, „ <br />Temperature <br />5- VN4/1/ ° tj a0112 eV1P1:W <br />F <br />W �yCertification <br />�_ Facility Hot Water <br />Temperature. <br />warewashidg <br />_ <br />Name: A Q—ko" 10 C 1'j l.F Hand Sink: <br />, 1 Ik� <br />�F Chlorine: <br />PPM <br />Heat: <br />F <br />Exp. Date: 4 Z 5 y 3 arewashing Sink: <br />I 1 �- <br />of Ouat. Amm.: <br />ppm <br />Other. <br />eF <br />Received By / Title: <br />EH Specialist: C' Lp <br />14 Fj t AA U 2D <br />Phone: 7— I>.9 <br />—.56 <br />Time in: .0 <br />O <br />. J . � 5• A <br />Time Out: e -. <br />5C <br />Page„ofz- <br />4 <br />EHD 1624 (2- pg) 4013 FOOD PROGRAM OR CONTINUATION <br />