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___ _JII IIA• <br />SAN JOAQUIN COUNTY <br />Z: ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�tFOP <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: —f 3-1 <br />/ <br />City: zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />!., I <br />P ogram Record: 65-01v2 <br />Inspection Type: rtuAlkLe <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />01�� <br />h8ldau <br />�t L. ev" <br />�� (�1L� �L���Itiul�,� -. s. <br />tbt <br />l V,1A e I <br />CUM <br />'t <br />I. <br />S <br />r <br />L!V [J <br />d <br />t <br />V <br />Hc ow -m- no <br />Item/Location <br />y ,.. <br />Temperature Item / Location <br />Temperature <br />Sa4l atoll -A- rArVil, i <br />VV <br />Food Safety Certification" Facltity;.. <br />Name: Sink: <br />C- <br />— r <br />:„ <br />F hlorine: 6PPM Heat: <br />�ff— <br />'F <br />Exp. Date: <br />shing Sink: <br />'F uat. Amm.: ppm Other: <br />`F <br />Received By / Title: <br />jj4areweand <br />t770 <br />✓ l 1 /', I� fA <br />CA Vl <br />EH Specialist: 0 WV fCi <br />Phone: _ I <br />Time in: I <br />Time Out: <br />Page'�if <br />EHD 1624 (2m pg) VT 3 POGO PROGRAM OR COWnNUATION <br />