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oR 'tt"�• c ,S'AN .JOAQUIN COUNTY <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. �a Telephone:(249) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: { i L� 4 Date: <br /> ddress: ; City: Zip Code: <br /> Owner/Operato : Telephone: <br /> Program Element: s+ Program Record: 2s Q� Inspection Type: <br /> B180 Posted Yes No V Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ' u <br /> t�D <br /> i ^ <br /> 12 0 20 o e <br /> An I <br /> 0 <br /> f <br /> r <br /> " L <br /> Tem ratum Ite !Location Temperatu71 <br /> _' �,�% � L l,ivt�►, c�Y try � <br /> — Foo I#Ication,. Facility'Hot Wate em nature Warewashing �. <br /> Name: Hand Sink: .F hlorine: ppm 'Heat: of <br /> Exp. Date: arewashing Sink: 'F Quat. Am-: ppm Other: of <br /> Received By 1 Tltie: <br /> EH specialist: Phone: Zd / D J <br /> C <br /> Time In: Time Out-L I Page of <br /> vi <br /> r <br /> EHp 16-24 (211 pg) 413113 POOL PROGRAM OIR CONTINUATION <br />