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,ae •.FA� SAN JOAQUIN COUNTY <br /> Rr ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East HaZefton Avenue, Stockton, CA 95205-6232 <br /> 4 -.. Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��Fddt' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� y /J/ �� - Date: Q— b <br /> Address: rj f ; City: �7 .� Zip Code: <br /> Owner/Operator: [ ' Telephone: <br /> Program Element: Program Record: � Inspection Type. y <br /> B180 Posted Yes No Permit Posted Yes No ' ' . Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> p ru I ? <br /> QLW 2 J <br /> �a �, . C + <br /> n <br /> _ •f 1 • fjA <br /> _ <br /> i/ / <br /> C r1 !L C7 ,7Q4 141 67Y r <br /> itemlLocation Temperature itemr/'Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing _ <br /> Name: — and Sink: "F Chlorine: ppm eat: "F t <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm ther: 'F <br /> Received By/Title: R/ <br /> EH Specialist: f - ,• Phone: <br /> ime in: Time Out: Page,of! <br /> A30tf <br /> FOOD PROGRAM OR CONTINUATION <br /> I HD 1&24 (2-pg)4fY13 <br />