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°¢ SAN JOAQUIN COUL _ ,Y <br /> k•-� -oma <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • <br /> jpoRi:� Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sogoV.org/ehd <br /> 4L + <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C Date: <br /> ®/ <br /> Address: CRY: Zip Code: r, <br /> DwnerlDperator: Tele ho <br /> Program Element: Program R rd: s <br /> z nspecti n Typ <br /> IS 8180 Posted ❑Yes ❑ No Permit Posted 0 Yes E NoC f! <br /> Re-Inspection on or After: <br /> `' i�BSERVAT�ONS AND`CQI�R�CTl�IE AC�iONS, -` <br /> IF <br /> J7 <br /> I <br /> r i <br /> ,c. - `, -• <br /> ttem/Loc;�tion `kT!Tem erafur item ovation Tem ; <br /> ratur 1#emllncation To. <br /> em ,rature <br /> o©d.Sa#ety'Certificaition - °' Hand Sink:filo Water;Trnperatare 'warew�r§hirJ <br /> Name: H - <br /> `F Chlorine: PPM heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: PPm they: ,F <br /> Received By/Title: <br /> EH Specialist: Phone: O� <br /> Time in: Time Out: . Page of <br /> EHD 16-24 (2n1 pg) 11!2149 <br /> FOOD PROGRAM,OIR CONTINUATION <br />