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SAN JOAQUIN COUN . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Cj <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd _ <br /> �(FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _C( - I <br /> Address: '�)o I City: Zip Code: <br /> Owner/Operator: '51 <br /> Telephone: <br /> Program Element: ` ,�k3 Program Record: U 2 G Q Inspection Type: <br /> Fin <br /> Posted \LJ ❑Yes E3Rermit Posted F]Yes ( J U Re-Inspection on or After: <br /> VV'l LL OBSERVATIONS AND CORRECTIVE ACTIONS }; <br /> - - — -- Ilt 1 � • <br /> c lr 4kw-' 1 <br /> ( ke- <br /> 120t�- s�2 <br /> 2 <br /> �5 1 <br /> Itemil-ocation Temperature Item I Location Temperature <br /> Sx-102 (tc <br /> Food Safety cation Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashi g Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: U �1 Com' Phone: ll <br /> Time in: (� Time Out: 1 ✓`J Page._,of <br /> EHD 16-24 (21 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />