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SAN JOAQUIN COUNTY <br /> i9�Q coc <br /> 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> h: <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` j C_ a Date: — <br /> Address: 5 ? C ��.� City. C Zip Code: S <br /> Owner/Operator: Telephone: <br /> Program Element: ,A` Program Record: 5 14 to 2 Inspection Type: <br /> B1e0 Posted Yes No Permit Posted Yes No Re-Inspection on or After: OJT <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G ` <br /> \t fe- a je- - h <br /> VNV�� te "Lot* e o cnAc L lira <br /> �\ e e <br /> item/Location , mperature Item/Location Temperature <br /> 7 <br /> 11 Food Safety Certification Facility Hot Water Temperetu WarewasWin <br /> Name: Hand Sink: aF Chlorine: PPM Heat: aF <br /> vV J <br /> Exp.Date: arewashing Sink: of Ouat.Amnm PPM Other: =p <br /> Received By/Title: <br /> EH Specialist, - Phone: <br /> ime in: Time Out: < " Page f Z <br /> EHD 1644(2^^pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />