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SAN JOAQUIN COUNTY <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INS ECTION REPORT <br /> Name of Facility: 77,TEA !�[4- 07.711 Date: 2 oL 3 <br /> ddress: 6 I din City: O Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: D!3, ! 90 Inspection Type: Q <br /> SB180 Posted Yes No Permit Posted es No `"! 7 Re-Inspectlon on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> / o dab s ✓eho' cic <br /> 2' l�a�i W s " ' r v. <br /> G; ; eN '*'ta /'-11 <br /> / aG1 G+-�7- w �a <br /> �N `n Z W <br /> /G - <br /> (1411 <br /> 3 <br /> G< �✓ l S.�t A-"' Qe <br /> cllvn <br /> ;�e AC a ri /hP f '-Doii <br /> 0. C <br /> !y/ /Lo r <br /> .r <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm Heat: eF <br /> Exp.Date: arewashing Sink: 'F 10 <br /> uat.Amm.: PPM ther: of <br /> Recelved By/Title: S cco / /4 rt,7�-,J-1A46 Dyi <br /> EH Specialist: p`r'/c- A� Phone: <br /> ime in: 1 -3s MI Time Out: ; 5 3 /"I 1z <br /> Page of <br /> EHD 1&24(2e0 Pq)4fd113 FOOD PROGRAM OIR CONTINUATION <br />