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oPq�l"• SAN JOAQUIN COUNTY <br />? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•.cd.... •...;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />C1FdR" <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:` tJ <br />Date: 01-11 <br />Address: <br />/ork4ar, <br />^ <br />e• <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />SB180 Posted es No Permit Posted Yes No <br />Re -Inspection on or After: <br />-' - AND CORRECTIVE ACTIONS <br />O OC <br />'f }► T 2po t•1 A <br />�1 <br />—e- D <br />LE atSPLN�gR. <br />ojpsomzvsSvj <br />rr <br />(� C.5Tb Ys <br />V <br />L <br />Item /Location -, Tem <br />i - bOa 1f - <br />Item/Location Temperat" <br />3f" K <br />.000 Safety Certification <br />Facility Hot Water Temperature <br />Chlorine: <br />Warewashing ....., <br />ppm Heat: of <br />Name: <br />Hand Sink: d� of <br />Exp. Date: <br />arewashing Slnk: <br />t��O <br />of <br />Ouat.Amm.. <br />ppm Other: of <br />Received By/ Title: <br />EH Specialist: GL LI • U `+ M / M' t AQ <br />'0 <br />Phone: .yp <br />^ <br />Time in: 9,00 <br />^ Q A M <br />Time Out: <br />:3; A Page of <br />EHD 16-24 (2b pg) 48113 FOOD PROGRAM OR CONTINUATION <br />