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oP441N•.c SAN JOAQUIN COUNTY <br />z ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• c.._ -- `P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />9GIFOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: (_ I <br />_ 2 3 <br />Address. ` <br />City: —�— Zip Code: a 5 3 <br />OwnedOperator: •` fie O <br />Telephone: <br />Program Element: `b'Z?J Pr gram Record: b Cl Inspection Type: <br />Bt 80 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />.. <br />M l7 <br />RRECTIVE ACTIO 5 <br />ZI q10 <br />se <br />u <br />a� <br />-c <br />- <br />b <br />-„A- <br />P <br />42-1 kano��LQ <br />I <br />RN)- <br />W��k- 1-U <br />s�r� tS33— <br />lc PC 4eps'r1kISS <br />2 IE: J42P -t- �A\D <br />o\ <br />f . < �Y;t F <br />2 ,ep 33 <br />cV ,- - o 1 k,:VS F <br />c <br />\'*A <br />'A4 F <br />hr e <br />`A 1 F <br />esS <br />`kq ii- <br />C1o� IS` -I1— <br />Facility Hot Water Temperature rewashing - <br />Name: L G�Hand Sink: \r�,^1 of Chlorine: Zl�^ PPm Heat: <br />VS`J5 V <br />1S4 <br />of <br />Exp. Date: , (_ 2� _ 1 _ <br />YJ <br />arewashing Sink: eF <br />Ouat. Amm.: <br />PPM Other: <br />aF <br />Recelved By I Title: <br />vJ <br />l U/ e <br />EH Specialis • - <br />�� <br />Phone:— <br />ime in: ' 2: S� <br />Time Out: (• 31 <br />Pag T <br />EHD 16-24 (2n° Pg) 4tN13 1 FOOD PROGRAM OIR CONTINUATION <br />