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aP��"+•.� SAN JOAQUIN COUNTY <br />? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />4.,.• ; Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'aov.ora/ehd <br />�1aolt`' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 09/✓N xS <br />Date: iy <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />B180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />Al 0 Al A9 cTo p_ <br />7. <br />OBSERVATIONS AND CORRECTIVE ACTIO <br />LfSi <br />b F <br />to <br />0 <br />950 <br />Zhg <br />f t2 #J t2 <br />h 4f L <br />Gtl As v <br />w t t✓ <br />A <br />Item/Loeal';to. <br />Temperature <br />S• c <br />`item/Lose oT <br />6 / <br />YD/V <br />0 <br />ood Safety Certification <br />Name: N <br />3 T <br />Facility Hot Water Temperature <br />Hand Sink: COQ <br />of Chlorine: <br />Warewashingl, <br />ppm Heat: �F <br />Exp. Date: <br />arewashing Sink: imp <br />aF <br />Oust. Amm.: <br />PPM110 <br />ther: =F <br />Received By/ Title: <br />EH Specialist: L_ /11- p q0 t <br />" <br />Phone: <br />6 <br />20 9 — 5 6 1 p 23 <br />ime in: <br />Time Out: /_57 <br />Page�of y <br />EHD 16-24 (2m Pg) 4/313 FOOD PROGRAM DIR CONTINUATION <br />