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ot*aglN•. SAN JOAQUIN COUNTY <br /> m '< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • r... ;a Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 9Cl FO RK <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 — Date: 9 - Z,4-11 <br /> ddress: 3 3 City: C 1- Zip Code: C' SZOI_ <br /> Owner/Operator. Ll K-- Telephone: to 5'1 _p VZ\-( <br /> Program Element: \\_ Program Record: S . Inspection Type: ^ V <br /> YJ g '\ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 2 \ <br /> CA� - c l a2-04 Or) <br /> - <br /> t l <br /> Lin \ ( e c eK r� <br /> l (4 <br /> -� - . 11 <br /> -X5i -\12 <br /> Item/Location _]_Temperature Item/Location, Temperature.. <br /> Food Safety Certification' Facility Hot Water Temperature Warewashing <br /> Name: : Hand Sink: ofChlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: aF Quat.Amm.: Ppm Other: of <br /> [eceived By/Title: <br /> Specialist: Phone: lt b �in: ' t Time Out: _l 1 ` 2 Page of <br /> EHD 16-24 (20 pg)4/3'13 % J FOOD PROGRAM OR CONTINUATION <br /> r� <br />