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SAN JOAQUIN COUNTY <br />? ENVIRONMENTAL HEALTH DEPARTMENT <br />_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•c... _ ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.ora/ehd <br />4Ci FO R� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />W udL3 <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: f i <br />ot rn <br />Telephone: <br />3�Z— 02 <br />Program Element: <br />Program R <br />ord: 0 ow <br />Inspection Type: <br />Set 80 Posted Yes No <br />Permit Posted Yes No Re -Inspection on or After: <br />tlkuq. <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />v <br />�2. M <br />z <br />C 6-!1? <br />711 GLC <br />�h <br />rA G <br />d <br />GI tCCe <br />( <br />✓ <br />! til ✓ <br />� �'1 %� <br />J <br />P4 1"I <br />i a r r <br />sA10U <br />plogi 1 ALI <br />/ry�In <br />ltirn <br />In tj �k1K <br />min . <br />K Ae <br />S t 0 <br />W Y9 N u <br />c ?4 -AS / <br />✓ <br />Y C t/K <br />LQ. L V�.(�lol <br />l l t� V , I h j' C. <br />ItemlLoeaflon <br />- <br />Temperature <br />- Item / <br />Location <br />Temperature <br />r.tx it -wt <br />✓ <br />3 cvY <br />27 - <br />Name: - a / <br />r <br />Faeiltiy Hot Water Tempereture <br />Hand Sink: =F <br />Chlorine: <br />Warewashing <br />Heat: <br />ppm I <br />"F <br />Exp. Date: ZZ <br />arewashing Sink: F <br />Oust. Amm.: <br />ppm <br />Other: <br />"F <br />Received By / Title: <br />— <br />EHSpecialist: <br />Imo„ I <br />V <br />Phone: <br />Time in: <br />Time Out: <br />Page of <br />EHD 16-24 (2nO pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />