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SAN .JOAQUIN COUNTY <br /> 3. 6G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Haze[ton Avenue, Stockton, CA 95205-6232 <br /> . r... ;P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.smaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r� rt Date: - <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: 1 Program Record: �'� �`A Inspection Type: <br /> Bt110 Posted Yes No Permit Posted Yes No l Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0( -q N- <br /> 3 " <br /> kA� <br /> �! 2 <br /> h 1 �yor - IC' r= <br /> SJ <br /> L1 A-0 <br /> "A -- <br /> e- <br /> 53 <br /> o 22 ?t- <br /> Item/Location I Temperature <br /> Lev <br /> - Facility Hot Wal�g PMR2Warewashing <br /> Name: Hand Sink: OF hlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of ust.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> Time in: ` t Time Out- Pagt�f <br /> EHII 16 24 (2 P9) AI31i3 FO0D PROGRAM OR CONTINUATION <br />