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oD4ylh. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> agLiadt'Na Telephone.(209)468-3420 Fax:(209)464-0138 Web:www.siaov.orD/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I Date: ?� <br /> Address: 3 2'( City: s a-4—u� Zip Code: / s� <br /> Owner/Operator: Telephone: 203 <br /> e 0.r lam, <br /> Program Element: r b3, Progr m Record: n .p q';_0 1-7 Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVATIONS AW CORRECTIVE ACTIONS <br /> Lteo"y` tL — 7 2-5'5- H L_ <br /> IJ e cz:� a r e fit cr neQ� �r1a sI // r �J <br /> I Pr^ ST <br /> 1� �� ��., ...,�.} u�.-I—r �_J �.�I'ri Wt rSSr.•r Fo�rvt i S 1 Gt¢.t< <br /> } re•f-ur»R�t - <br /> 11emYL . em - Item/Locatton.. >- - <br /> Facility Hot Water Temperature , , , Warewashing <br /> Name: Hand Sink: 'F Chlorine: PPM 11 Heat: "F <br /> Exp.Date: arewashing Sink: 'F Ouat.Amm.: PPM ther: `F <br /> Received By/Title: <br /> EH Specialist: /'jte� Phone: Z cJ cf 307 cD <br /> Ime In: If <br /> D . Time Out: 2 S Page/of <br /> EHD 16-24 (2-pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />