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aa�'�` •sA ++'t�'y.•r� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,,QA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.+7rglehd <br /> .f <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: &14 1� �� � ' Date: <br /> Address: I.z r��' City: ) Zip Code: <br /> caner/Operat1or: !f / Telephone: i <br /> r - <br /> Program Element: i// `Program Record: f7 2 Inspection Type: L <br /> 6180 Posted Yes f (NJo Permit Posted Yes ! No Re-Inspection on or After: <br /> r <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> . .vVLA4 i tz-74 <br /> J r <br /> ti..1 ✓ '-j <br /> 4qr i 6 _ <br /> 2 <br /> r ' <br /> arr�• / d � � _ CvS <br /> ftemlLocation Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature _ Warewashing <br /> rEDate: <br /> and Sink: eF hlorine: ppm eat: eF <br /> arewashing Sink: o f uat Amm.: ppm then: "F { <br /> EHp]e <br /> By!Title: <br />+, alist: f " � �"' + Phone: a fr Time Out: , Page I of <br /> EHD 1624 (2 i pg)4F3r13 -•'FOOD PROGRAM OIR CONTINUATION <br /> ZZ <br />