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SAN JOAQUIN COUNTY <br />b ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />r... 'p • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siclov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />` Date: <br />Z 3 <br />Address: Z I <br />City: 7 r Zip Code: <br />q <br />Owner/Operator: <br />Telephone: <br />Program Element: ` Z <br />Program Record: 5 2 2 Inspection Type: <br />`l <br />B180 Posted Yes No <br />Permit Posted Yes No Re -inspection on or After: <br />BSERVATIONS AND C ECTIVE ACTIONS <br />Z <br />e e <br />e <br />Sic, 2 =l. e girgp <br />�-f I <br />c <br />re s' <br />121 F ce l bl <br />mpera@ e' <br />e e <br />"IT -7 <br />ow e. l I <br />SZ- <br />eI <br />k-1 I <br />3s F <br />0 5 i <br />ooU.Safetty CerMcaq <br />Name: <br />12) = P_ o S=4- <br />- Facility Hot Water Tempera _�.' washing! <br />Hand Sink: I V 'F Chlorine: I PPM Heat: IF <br />Exp. Date: `2 Z 2— 2� arewashing Sink: `F <br />Ouat. Amm.: ppm <br />ther: =F <br />Received By/ Title: <br />EH Special! s • <br />— Phone: <br />Time in: y 1 - ,^O <br />Time Out: `� r� <br />Pagol <br />EHD 16-24 (2^ pg) 4/3f13 FOOD PROGRAM OIR CONTINUATION <br />