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r aPau!n. <br />�' ��f?G <br />9CIFOPe� <br />SAN aJOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date:O 1 —O <br />Address: City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />B180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />t -A -r l nil I Pt✓r1T t �l D. <br />- <br />Rem/Location i ^-Temperature <br />Item Location <br />Temperature' <br />Food Safety Certification Facility Hot water Temperature <br />'Warewashing <br />Name: `, L q .Dt 1Z Hand Sink: I <br />�F <br />'Chlorine: I .00 ppm Heat: <br />�F <br />Exp. Date: O 9- D 3 _ 7.0 arewashing Sink: L21 <br />eF <br />Oust. Arl ppm Other: <br />'F <br />Received By/ Title: <br />EH Specialist: f:.. tM 14 P I A -A4 u Ill <br />Phone: Zp i5:11l ?72-5 <br />Time in: / d r m <br />Time Out: I ; Y 5 P <br />Pagf> Of7-1 <br />16-24 (2m pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />