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e �{ ••� r",ti ♦ ,•.�+, ti^ �"..• •� •il.T•ti}>•.I,r'.+'�� 1t`'�`�. r � � —. r•� .-r F��• � � 1Y �a�;' � <br /> oP�ulty 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.s1qov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 4._ Date. ;12— <br /> ddress: , •` City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: t 4cl, Program Record: ��t_t c;� Z Inspection Type: <br /> BtBQ Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> / OBSERVATIONS AND CORRECTIVE ACTIONS " <br /> J <br /> ic- <br /> ` 1 <br /> � y <br /> �'- i G`•�] ��` -P�L-Grp 1 �—� <br /> w Item/Location Temperature Item/Location Temperature <br /> "Food Safety Certification Facility Hot Water Temperature Warewashing ,- <br /> Name: Hand Sink: OF hlorine- ppm eat: OF <br /> Exp.Date: Warewashing Sink, OF uat.Amm.: ppm her: 'F <br /> Received By/Title: h i r I b l Ul I•�l. 4f ��' <br /> EH Special Est: `t Phone: , <br /> Time in: - Time Out: -;, Page—ot <br /> f EMD 16-24 (2'd pg) 413113 1 FOOD PROGRAM OR CONTINUATION <br />