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SAN JOAQUIN COUN <br /> _ Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . •.: - iP• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> ACjF�`iia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: vn City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: / Program Record: Inspection Type: ` <br /> 8180 Posted (•� ❑Yes ❑ Rermit Posted ❑Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> iA <br /> �' i1 fit <br /> vlv Ove c k._ Sa LC <br /> Vtl 6t vLd nn <br /> � i'1-urwv�d� �e.�v�,o .1� ea�� cite evvw�`c Gtvc� <br /> P1. <br /> J6 kk vim" &Akw <br /> av> h-Eco <br /> u " <br /> ln.e +� <br /> t <br /> G'v` o'" >A 4vi- <br /> C r � <br /> ltemLocation 1 Temperature <br /> Facility Hot Water Temperature F Warewashing <br /> Name. Hand Sink: of Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: F Quat.Amm.: ppm Other: °F <br /> Received By/Title: <br /> IN <br /> EH Specialist: Phone: <br /> Time in: Time Out: Pagd-7 o <br /> EHD 16-24 (2n1 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />