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°"�" SAN .�OAQUIN COUN' <br /> pp........ C <br /> So.. <br /> o.�'•.O <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 44 Date: 777 l <br /> Address: �/� City: Zip Code: <br /> Owner/Operator: a� er Telephone: W <br /> Program Element: Program Record: !� '1 s Ins tionY py:( <br /> 2 <br /> IS 8180 Posted ❑Yes 11111 Posted ❑Yes El / Re-Inspection on or After: 'V <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t : <br /> JA kdM a ' .e,�1;A-GVH G <br /> a4 l i ( k <br /> eu <br /> Q�WL <br /> ODM(1A <br /> o AYmAff 'd <br /> v (� <br /> a <br /> ItemlLocatio� Temperature item t Location . <br /> Facility htr ?mP� ,. si �_ Q rewashing _ _.. <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Titley <br /> EH Specialist: z 61761 CL Phone: <br /> Time in: Time Out: Page of <br /> .HG 16-24 (2''pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />