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aPR�`"••F SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> 44IFd•PN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: eiA 6 D <br /> 1 iM City: Zip Code: <br /> Owner/Operator: 1 t �,I n e a Telephone: <br /> Program Element: Program Record: O� Inspection Type:. <br /> 8180 Posted No Permit Posted Yes No Re-Inspection on or After: <br /> RVATIONS AND CORRECTIVE ACTIONS f T <br /> IrS re- nS ez M. as v/1) MIS <br /> Y D7—i <br /> Item/Location Temperature Item 'Locatlo <br /> Tj Food Safety Certifirad _ Facility Hot Water Temperature = _ Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: I Time Out: Pag f' <br /> EHD 16-24 (2nO pg)413/13 FOOD PROGRAM OIR CONTINUATION <br />