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�a�ln F SAN J0,*QUJN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> U�4' ' Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION 'REPORT <br /> Name of Facility: _ /tom b(_ ibaZDate: 2 _ 70— 246 <br /> Address. r L> 1__. City: r Zip Code: <br /> I� <br /> Owner/Operator: Telephone- <br /> q <br /> Program Element: q ' Program Record: R Inspection Type: <br /> t <br /> FB180 Posted Yes No Permit Posted Yes No ' f Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l l � <br /> 1 <br /> r f t <br /> z <br /> Y � I <br /> e 1 t <br /> r CN-1 LA <br /> 4 <br /> s a 6,44w VD 4f Ab u,/. <br /> Aj <br /> )7 Item/Location Temperature Item 1 Location Temperature <br /> - -- � V 1n� u �" <br /> t e r rl.G .dam. <br /> i <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: �- and Sink: 'F Chlorine: Ppm Heat: "F <br /> Exp.Date: - arewashIng Sink: 'F uat.Amm.: PPm r <br /> ther: -F <br /> Received By 1 Title: <br /> EH Speciallst: Phone: <br /> Time In: � Time Out: Page io <br /> EHD 1B-24 (2-pg) 413fi3 ! i FOOD PROGRAM OIRboNTINUATION , <br />