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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />a4c)aGA�;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sogov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />. lci <br />Date: <br />'q <br />ddress: 1 <br />��I <br />City: <br />N Zip Code: <br />Owner/Operator: <br />Telephone• <br />Program Element: <br />Program Record: <br />2 1 � <br />Inspection Type: <br />B180 Posted Ye <br />No <br />Permit Posted es) No <br />Re -Inspection on or After: <br />N 10 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />I 6I N-PIZV <br />CWRY belbAl4UbMeVS- <br />3Lo r -7- <br />3 <br />34F- <br />l c <br />P- -F)r <br />4tF <br />1 r <br />6 C— <br />b 151 <br />ae <br />t <br />I� t , <br />'f1211 �— <br />I <br />F <br />ood Safety CertNi <br />, cllhg. Hot Water T_empera4i rewashing <br />Name: <br />and Sink: <br />of hlorine: ppmHeat: <br />"F <br />Exp. Date: <br />arewashing Sink: <br />of uat. Amm.: ppm <br />her: <br />of <br />Received By/ Title: <br />EH Specialist: <br />Phone: <br />Time in: <br />Time Out: <br />Page of <br />EHD 16-24 (2r9 pg) 4/3113 1 FOOD PROGRAM OR CONTINUATION <br />