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C <br />oPAMIfi• c SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />��ciFoavr Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.ora/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />7 . Date: ( <br />1-7-23 <br />ddress: I 1 <br />City: Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: 1 ct Program Record: 1 (3 Inspection Type: <br />B180 Posted Yes No Permit Posted Yes No Re -Inspection on or After: <br />She 1 <br />\ <br />BSERVATIONS AND COAH G, 111E P CTION. <br />- <br />x ole- <br />- D_Q 2 <br />Com, <br />3 4-e \Jk z <br />1 '\ <br />/ <br />�� <br />-t s m <br />PA <br />S7—.50g <br />c� <br />!e <br />\ Q cl <br />e k S <br />e -t- <br />7\J\ vO 5 i - 1 t- K-� <br />-- - -tILI <br />1 Op_ 4z'�7, 2 \cl <br />q0 <br />32 <br />\ 'Oe \ F; e <br />,Al3 co <br />-too Coco <br />Safety Certification <br />INEWK cility Hot Water Temperate Warewashingi <br />Name: <br />Hand Sink: of rhiorine: PPM Heat: <br />of <br />Exp. Date:arewashing <br />Sink: OF ual. Amm.: PPM ther: <br />OF <br />Received By / Title: <br />V <br />EH Specialist: <br />Phone: .^ <br />`VI <br />Time in: k C C60% <br />Time Out: C. 1 .^ <br />Page f (j <br />EHD 16-24 (2^ pg) 4P 13 <br />FOOD PROGRAM OIR CONTINUATION <br />Im <br />