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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />c°�ikaR P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT, <br />Name of Facility: <br />a j <br />Date: p <br />ddress: /, 1 <br />I City: <br />Lai <br />ZIP Code: <br />Owner/Operator: //IWC <br />, , <br />f <br />Telephoned-:' M— <br />// <br />Program Element: <br />Program Record: �/ 17 <br />V <br />Inspection Typeft /n <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />r%RQF:KZX1ATIONS AND CORRECTIVE ACTIONS <br />,040 <br />t, e <br />r- Ir <br />-rvt_ <br />4:mper ature <br />F <br />I <br />N <br />d Safety Certification) Facility. Hot Water Temperature <br />Name: and Sink: <br />"F hlorine: <br />Warewashing <br />ppm Heat: <br />'F <br />Exp. Date: <br />arewashing Sink: <br />of <br />uat. Amm.: <br />ppm Other: <br />of <br />ed By / Title:ecialist: <br />F <br />��/-LPhone: <br />!/,: <br />V V <br />Time Did: <br />1 <br />Page ' of <br />EHD 16-24 (2� pg) 4013 t FOOD PROGRAM OIR CONTINUATION <br />