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SAN JOAQUIN COUN . <br /> � •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sagov.org/ehd <br /> �iFoac+ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: c Date: Z_j_q_ <br /> Address: City: jG_A_,Sy_\ zip Code: G 5 Z O <br /> Owner/Operator: _I 1 1 1 I Telephone: <br /> Program Element: t Program Record: C U c)c'— Inspection Type: <br /> 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ 1 v Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Q� w-e-sz- <br /> _ Q <br /> h <br /> rtr -4 <br /> 1,A " I <br /> Y-\aj� (o-n,J <br /> ,..: — <br /> Q 5;Ap, - - <br /> Item/Location Temperature Item/Location Temperature <br /> — wA v0\Q n <br /> 1i Warewashing <br /> Name: Food SafetyCertification `Hand Sink:Hat Water Tempe of (Chlorine: ppm (Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 1.1 <br /> Time in: , 50 Time Out: ` Page If <br /> E H D 16-24 (2n1 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />