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SAN JOAQUIN COU4 <br /> Op........ C <br /> ).•'fir'•,pG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Cq•. �P Telephone: (209)468-3420 Fax: (209) 464-0138 Web:vvww.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M Date: u b (S <br /> Address: 22 1�_ City: ` Zip Code: 9 3 <br /> Owner/Operator: ;`� ` Telephone: <br /> Program Element: `k-1S Program Record: , Inspection Type: <br /> Vffi8l)Posted Yes ❑ Rermit Posted xyes ❑ I Re-Inspection on or After: <br /> w _OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 T� 'il_. 1 <br /> C S 1r,=. sz z �. C 1 <br /> ��.,. C� to <br /> 1` C, <br /> Aa,. -k <br /> Itemll-ocation Tem nature Item/Location ml <br /> F <br /> C=, kor _ 1 C `RS t <br /> C6 r <br /> s, ,, ood Safety`Certification �Facllit ,Hat Water Temperature Warewashing .. <br /> _. . .._ <br /> ` , • >, <br /> Name: Hand Sink: of Chlorine: ppmHeat: F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: Ct <br /> EH Specialist: Phone: 14,0 <br /> t10 2_ <br /> Time in: ,, Time Out: , O Page of <br /> EHD 16-24 (2^d pg) 41113 FOOD PROGRAM OIR CONTINUATION <br />