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r oR0.t!Iti• a SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />8d..,. ,... r Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />�1FbaN <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Com. t 1;00 to 1A I <br />Date: 2., ..• Z 3 <br />Address: ' O 5F,AC4AM —rD trr City: <br />Lo zip Code: zv0 <br />tr <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 />OBSERVATIONS AND CORRECTIVE ACTIONS <br />10 MON ST Rl <br />Xf ON S <br />,4 ZU 45;W6 20 2 3 <br />PE 70A I V <br />Lic I N <br />Item/Location <br />0 P CO OG <br />Temperature <br />Item / Location Temperatu AF <br />'Food Safety Certification <br />Facility Hot Water Temperature <br />,� Warewashing Pa <br />hlorine: Ppm Heat: =F <br />Name: 1• '� <br />Exp. Date: �, 2 .� <br />Hand Sink: / <br />of <br />arewashing Sink: /6V <br />of <br />uat. Amm.: ppm <br />r <br />IP ther: =F <br />Received By/ Title: <br />1 �1 <br />H Specialist: C.r.. A to D I A rA 4 <br />Phone:so ^ 7b 51' ,� 8 .L ,3 <br />Time In: <br />Time Out: Pagwf .� <br />EHD 1624 (2b pg) 4I 13 FOOD PROGRAM OIR CONTINUATION <br />