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SAN JOAQUIN COUNTY <br /> ).• �a Fqc <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ••�q.., ..�P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sictov.ora/ehd <br /> �IFOFN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 -1 Date: , 2 <br /> Address: S ' ro\ , �\J ` city�- Zip Code: <br /> Owner/Operator: ,/1 Telephone:? -63b- bo-z <br /> Program Element: `1 _Z Program Record: S �a Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Pc�S N ir <br /> CA C C e5 I <br /> 5 i s of cc es I <br /> (A \ a -C— AF <br /> _ - -ItemlCocatio Temperature Item ILocation- - Temperature <br /> TC si. - <br /> I-11 IF <br /> 2 2 (v'Q- -F r z-Q­� 2l <br /> C 3 1F \c\ C <br /> Food Safety,Certification. Facility Hot Water Temperature - _ -Warewashing` - <br /> Name: Hand Sink: 100 of Chlorine: PPM Heat: 'F <br /> Exp.Date: 1 arewashing Sink: 1.,'2 - "F Quat.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: hone: _ �O I _ 1 _ 2-s <br /> Out Time in: ` : 2 Time .rL� 1?� Pag f <br /> EHD 16-24 (2m pg) 413113 FOOD PROGRAM OR CONTINUATION <br />