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.Jty �y <br /> SAN JOAQUIN COUN I Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1888 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �a•... ..�;�p Telephone:(209) 468-3420 Fax: (209) 464-0938 Web:www,siaov.org/ehd <br /> LfFOR <br /> f <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I d Date: <br /> Address: :52 t'�bt� City: 40CK_b� Zip Code: } <br /> Telephone: 95 <br /> Owner/Operator: <br /> �lh 1 �OaJ (�OYT C{'(oS` 3140 <br /> Program Element: I t0 0O Program Record: co 6,C) Inspection Type: � �+ <br /> SB184 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After. <br /> QBS RVAT{ONS•AND CORRECTIVE'ACTIONS. <br /> ep ✓1 v I nl I L4 r Iz <br /> .-a +y . <br /> A— &Y r r 5 <br /> `&Vk r_ � <br /> E <br /> Ili <br /> 1 <br />! <br /> ]temlLocation Temperature Item 1 Location Temperature. Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 4F._Chlorine: ppm Heat:, 'F <br /> Exp.Date: WarewashirDg.Sjn4t"— of Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone; <br /> Time in: ime Out: ; f,$ / Paget of <br /> i 130 <br /> EH 16-24 (2n1 pg) 419112 tJ FOOD PROGRAM OIR CONTINUAT€ON <br />