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4R�u'"•s SAN JOAQUIN COUNTY <br />` ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• c•... :p • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web; www.sigov.org/ehd <br />'C7i=day' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />1-1 <br />Date: (_ 1 -Z <br />ddress:'3 J� <br />, ` <br />Q Q <br />City: _T(-� C Zip Code: S s� <br />Owner/Operator: <br />1 I 5�,e <br />Telephone: <br />Program Element: Program) ord: o � '-AInspection <br />Type: <br />(W <br />B180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND C <br />E TIVE ACTIONS <br />Q <br />m <br />perature <br />jp.-.. <br />( s7 r \00 <br />r 1O+ - <br />s; t�k- VZ3 <br />ood Safety Cert01cat1' <br />ame: 1 ` C <br />cility Hot Water Temperature <br />Hand Sink: 'F <br />Warewashing <br />Chlorine: PPM Heat: 'F <br />Exp. Date: <br />arewashing Sink: <br />'F <br />uat. Amm.: PPM Other: oP <br />Received By/Title: S <br />C=am, <br />1. <br />H Specialist: <br />' \ <br />2/o C'\ - b to _ <br />Time in: \ 2 3 <br />Time Out: `2 ; S� Page f <br />EHD 16-24 (2� Pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />