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o.P¢41N•.c SAN JOAOUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />644aewav Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Address: 1 e City: <br />Zip Code: <br />Owner/Operator: °f , �j <br />Telephone: <br />, <br />Program Element: le 3 S Program Record: A--) G �-L 67 <br />Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />• BSERVATIONS AND CORRECTIVE ACTIONS <br />Pa La 4U 12011 44 042 <br />-, <br />Q Cioa1-- <br />3 _ <br />D lJl'hr ', <br />.._-Bem%Location �I' <br />ho rd L Z <br />- <br />ature <br />2� <br />3pl,. <br />Vit rk <br />NN ood. Safety Certificatlq Facility Hot Water Temperatuk <br />Name: �y ✓' � Q !� �, _ L, � Hand Sink: <br />(/� <br />>FLhlodne�:. <br />washing;. <br />ppm Heat: -F <br />Exp. Date: arewashing Sink: <br />-F <br />ppm ther: =F <br />Received By/ Title: <br />EH Specialist:��/ y 2..— <br />Phone: <br />_ / b — <br />Time in: U <br />Time Out: <br />1 age of <br />EHD 16-24 (2oO pg) 41313 FOOD PROGRAM OF CONTINUATION <br />