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oaa"'"• SAN JOAQUIN COUNTY <br />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 />ctFa'R+ <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date:/// <br />Address: <br />c, <br />City: <br />Zip Code: <br />Owner/Operator: <br />iy, C !_ ..N <br />Telephone: <br />Program Element: <br />!)_3 Program Record:< <br />iF-n / / <br />/\ <br />Inspection Type: <br />B1 BO Posted <br />11 Yes ❑ Rermit Posted <br />El Yes ❑ f <br />Re -Inspection on or After: <br />m; .OBSERVATIONS AND CORRECTIVE ACTIONS <br />.......-, <br />`. <br />J) C lkrnp <br />rte- <br />1 <br />r D <br />x <br />Itemll-ocatiion Temperature if <br />Food Safety Certification Facility Hot Water Temperature . ,.... ,--. <br />Name Hand Sink: <br />`7GCC' I� (��6 fni1c <br />Exp. ate: :'�'7/ nk: _ arewashing Si - - <br />Item FLocation Temperature <br />Warewashing <br />of Chlorine: Ppm Heat eF <br />eF Quat. Amm.: ppm (Other eF <br />Received By I Title: <br />/ <br />EH Specialist: f f,. <br />Time in: � y <br />Phone: <br />Time Out 11 <br />ob <br />/n r <br />l!/ Page of <br />EHD 16-24 (2^ pg) 03113 FOOD PROGRAM OR C04TINUATiON <br />