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�o.P4 ,eoo SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.si.gov.org/ehd <br />4POP� <br />FOOD PROGRAM OFFICIAL INSPECTION RFPnRT <br />FName7Facility: <br />Date— City: f ZipCode: Telephone: <br />h Program Record: S� C Inspecti` <br />❑Yes ❑ permit Posted ❑ Yes ❑ 1 <br />Re -Inspection on or After: <br />OBSERVATt0NS'AND CORRECTIVE ACTIONS <br />1 C <br />e e q <br />C\Y-4- <br />e if C22,1 -5'I 4e ' �C ee e <br />r e r -S <br />ea, <br />5 <br />I \oca,-k <br />C\ <br />'s 2 s sok 'P <br />d <br />—� <br />Item/Location ` Temperature <br />__.. <br />fItem <br />I Location :; a <br />--.- f.: ..-. <br />,�'emperature.. <br />e <br />c�11,�;�e <br />1ST <br />rA b '\ e <br />u I F <br />Food Safety Certification Facility Hot Water Temperature arewashing <br />Name: Hand Sink: 0 e hlorine: Heat: <br />�� j\r i--�llA I�7 F SQ PPM _—_ oF_ <br />Exp. Date: _ - i , z arewashing Sink: 12� <br />`2J <br />of uat. Amm.: Ppm <br />ther: ,F <br />Received By I Title: <br />C 1 <br />H Specialis ' <br />Phone: Z�_ b 31 5 <br />b - <br />!me in: \ l' ` 1 <br />Time Out: `` y 2 PaggZ 2- <br />EHD 1624 (2n°pg) 413113 1 1 FOOD PROGRAM OR CONTINUATION <br />