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SAN JOAQUIN COUN' <br /> p .. <br /> .X ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L Date: <br /> ddress: SJ h City: Zip Code: <br /> Owner/Operator. P/ Telephone: <br /> Program Element: V Pro ram Record: Inspection Type:j P1 <br /> 6180 Posted es F1 Permit Posted es El Re-Inspection on or After: tilil�L C- <br /> _1 <br /> Q " <br /> OBSERVATIONS AND CORRECTIVE ACTI0 S <br /> -O -Im J <br /> utoe <br /> ✓L L l�LG{,� H E C <br /> _. 17C1 <br /> -- r A. 1;a"j <br /> Item/LocationTemperature v tern 1 Location Tem eratu�e, <br /> Ur <br /> Food Safety Cert'ficatton acpity Mot Water Temperature_ ` �' Warewashing <br /> Name: Hand Sink: ;r of Chlorine: ppm Heat: of <br /> Exp.Date: (� arewashing Sink: / of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: LAW— V <br /> Time in: O Time Out: i G► Page f <br /> EHD 16-24(21d pg) 4/3113 l FOOD PROGRAM OIR CONTINUATION <br />