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'5. a"'" SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siov.org/ehd <br /> tt�a� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 1- -30 - <br /> Address. <br /> I G . Ln , city: � zip code: of 5-X <br /> Owner/Operator: E i. 1 j Telephone: <br /> Program Element: CDC) Progr m Record: L(7 3 rU Inspection Type:" 44if o <br /> SB180 Posted Ei Yes ❑ No Permit Posted ❑Yes C No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �t es //t��7v� c C' '. Gt <br /> 110 <br /> Ike IZIC' _ ,' A ed car r �, RR-SaE <br /> TU S at SA�GI C?r C i h yfp j t c- /IrL F <br /> ���-I r •� !c, <br /> Item/Location Temperature item/Location Temperature Item/Location Temperature <br /> .Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By 1 <br /> EH Specialist: 1 Phone: �I� <br /> ime in: [ o ; Time Out: , 3v Page jof` <br /> EHO 18-24(2n°pg) 41WI2 FOOD PROGRAM 0IR CONTINUATION <br />