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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cp... s ,�(P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.orq/ehd <br /> 4�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M`i t. ' Date: <br /> Address: ✓ aC Clty: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted 0 Yes 0 Rermit Posted Dyes DI Re-Inspection on or After: i �r <br /> µ._ OBSERVATIONS AND CORRECTIVE CTIQN$ l <br /> _( � N <br /> I <br /> ✓UI U XVA✓ W rA yew <br /> t <br /> 0I S <br /> A 140 ✓IM h — D <br /> L <br /> L—(&A <br /> k� till <br /> c <br /> t 0 (A <br /> If q V" Mm <br /> r . <br /> ItefmlLocation � Temperature i � ,—t L � Item Location � Temperature <br /> LI <br /> F� ►��ct�,.ltG6tr� � �v-u-� U—� 7 W�'u 1 7 �t�CirU 1 t�— r�ld�vviNv� � F <br /> fi SmKII ID <br /> Name: Hand Sink: `F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: `F Quat.Amm: ppm ther: 'F <br /> Received By/Ti le: <br /> EH Specialist: , _p Phone: I..�Y <br /> Y! <br /> Time in: ow <br /> ^ Time Out: ge bf <br /> Pa <br /> EHO 111-24 (2^ pg) 413113 FOOD PROGRAM OR CONTINUATION <br />