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SAN JOAQUIN COUN' <br /> p .. <br /> �¢ c�G <br /> '+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sggov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; (7) Date: ly S <br /> Address: S• fi C�Gt City: Zip Code: <br /> Owner/Operator: /, �/ Telephone: <br /> nd, a'/ i <br /> Program Element: 91a_ Program Record: jl `I„ G d' Inspection Type: <br /> 6180 Posted C Yes ❑ Rermit Posted (/ / 4 F Yes F I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l � X,zxvq kA <br /> Itemlt o femperature miler <br /> ��� e ature <br /> lGs� <br /> Food Safety Certification FacilityHot Water Temperature Warewas1Wng <br /> Name: Hand 11 Sink: of Chlorine: ppm Heat: <br /> °F <br /> Exp. Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: I S / Time Out: �l Pageff <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />