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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.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />ame of Facility: <br />_ <br />Date: (-13— Z. <br />ddress: � <br />\1 City: <br />C Zip Code: C, <br />wner/Operator: <br />Telephone: <br />Program Element: <br />_1 _ O <br />Program Record: I bl Iloilo <br />l \ <br />Inspection Type: <br />B180 Posted ❑Yes ❑ Rermit Posted ❑ Yesof <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />c, i C-rl'2 &Q., <br />,yam%�q1, ..-_,�-� Item/RO� <br />- -_" ': T edY1 <br />tem/Lacat7�f Temperature <br />LL.. _ FoodSafety Cecaf0 <br />Name: Il _ <br />r Facility Hot Water Temperature Warewashing <br />- - - Hand Sink: of Chlorine: ppm Heat -F <br />Exp. Date: <br />arewashing Sink: <br />aF uat Amm.: ppm <br />Other: >F <br />Received By f Title' <br />sec" O -- <br />EH Specialis ' <br />Phone: 20ci _ b 1 b _ 025 <br />Time in: C-4 �, <br />•20 Page f <br />Time Out: ll' -2-0 <br />EHD 16-24 (2o0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />