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SAN JOAQUIN COUNTY <br /> Pqu�!y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . -.. iP• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sj�gov.orq/ehd <br /> 4�rFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> L.. 1 <br /> Owner/Operator: Ao AL Telephone: q 6 3 r �?/p <br /> Program Element: Program Record: Inspection Type: f� �r <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> SERVATIONS AND CORRECTIVE ACTION . <br /> c l • <br /> i er A tal;rk ,crJ? S1 /t <br /> l <br /> MLIL) i <br /> L7 j!j <br /> r <br /> c <br /> ." 0 o � sN� S o� %� >'?� <br /> r <br /> l 20 2 3 - C1 dYl�Z <br /> 4? . <br /> Temper-' re ocai emperature <br /> �. co <br /> 163 <br /> Hot Water TemperatureONEL—Aarewashingl�EIiiiiiiiiII�_ <br /> Name: Hand Sink: °F Chlorine: ppm Heat: 'F <br /> Exp.Date: f 1warewashing Sink: of Quat.Amm.: ppm ther: OF <br /> Received By/Title: <br /> EH Specialist: V Phone: / ^ <br /> Time in: Time Out: q r F��� Page of <br /> EHD 16-24 (2^a pg) 4/3/13 O FOOD PROGRAM OIR CONTINUATION <br /> ! <br />