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SAN JOAQUIN COUNTY <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . .. Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C Date: <br /> Address: Ll / City: laC zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: 116 1-c Program Record: -7 Inspection Type: <br /> SBI80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 4'et CPA <br /> A <br /> AAndL <br /> rz <br /> .r h <br /> �• It '�� @.0 � ��`'!'y <br /> 3, <br /> f w" fig G <br /> Temperature Item I Location emperature <br /> Facility liot Water Temperature W are washing; <br /> Name: Hand Sink: 'F hlorine: ppm eat: 'F <br /> Exp. Date: arewashtng Sink: 'F uat.Amm.: ppm they: "F <br /> Received By I Title: <br /> EH Specialist: } Phone: <br /> t ' <br /> ime in: q Time Out: �j G, Pagelof 31 <br /> EHD 16-24 (2n°pg) 413J13 FOOD PROGRAM OIR CONTINUATION <br />