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%M01SAN JOAQUIN C0UN'1W <br /> � <br /> k•' `.. , <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .• 4 rz a`p•. Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> LlFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> V Date: <br /> Name of Facility: � �e v � �' A r en(r3. K <br /> Address: 1 O!� City: YAC Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: IQ c(4 <br /> SB160 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS: <br /> A 12 c- R r"o5 ar d <br /> Netrill.ocation- Teinperalure.. itern.4 Location Temperature <br /> !`ood SafeiyCOrtification warewastii ng <br /> Name: Hand Sink: -F Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: 9F Quat.Amm.: Ppm ther: of <br /> Received By I Title: <br /> EH Specialist:' Phone: p <br /> Time in: Time Out: Page of <br /> EHD 16-24 {2'I pg} 413113 FOOD PROGRAM OIR CONTINUATION <br />