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o.R4�l�•.s SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> n• ;a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.oro/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - Date: <br /> Address; \Z `O City:—Tr Zip code: <br /> Owner/Operator: Telephone: <br /> Program Element: ,b ZS Program Record: 1 b Z �Q Inspection Type: _ <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ER1/ TIONS ANQ C RRECTIYEACTIONS. <br /> W"YYQnJ <br /> - -1- 22 <br /> \ e e-c� e \ e c oc k foo. � +1-e r <br /> .,J r n e� e_ <br /> A - kQ 1 _ c1 'n CA <br /> e g t <br /> C Q i - I 1Z2 <br /> II-1-1 - 2 cr 10- tq- 22') . C <br /> i LQ <br /> e <br /> 1 C\ <br /> T A <br /> 2 \ <br /> ° ttem/Location - rsture tt Joeation <br /> Food Safety Certiticat! Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ?� of Chlorine: ppm Heat: °F <br /> Exp.Date: arewashing Sink: I of Ouat.Amm.: ppm 11 Other: of <br /> Received By/Title: �qr��e �'/bv <br /> EH Specialist: Phone: Zoc�— 10110 02S <br /> [me in: 1 1 I. <br /> — Time out: ( S Page ?f <br /> EHD 1624 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br /> 5 <br />