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pLily SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 14: - X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:{209}464-0138 Web:www.sigov.org/ohd <br /> oRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: bate: /y r <br /> Address: City: Zip Code: <br /> OwnerlOperator. [z0 ralwr <br /> lephone: <br /> Program Element- 1� Program Record: Inspe tion Type: <br /> 110 Posted Yes 0 No Permit Posted Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> unm 3, u , A <br /> Ab. <br /> �. / <br /> r <br /> [ w <br /> /4'�— A'zj r".;60LU 1"'k C <br /> E J <br /> l <br /> Item/Location Temperature Item 1 Location Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp. Rate: I 6washing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By I Title: <br /> EH Specialist: Phone: 33 <br /> Time in: t Time Out-.- ! Page �of <br /> r <br /> EHD 16-24(21'pg) 410112 FOOD PROGRAM OIR CONTINUATION <br />