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SAN JOAQUIN COUNT <br /> r. 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ..: = ;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> q�,FaRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: fP Date: <br /> Address: � �G � ,LYV�L City: Zip Code: <br /> Owner/Operator: p Telephone: <br /> Program Element: y Program Record: ^� ( Inspection Type: �)� L._ <br /> 6180 Posted ❑Yes 11Rermit Posted E.Yes ❑I J Re-inspection on or After: i�� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r vvL 41, - <br /> tit ✓t_ �-L <br /> OVA 4Z j <br /> L' k 'W <br /> _ a-e t-c <br /> s� <br /> Q lJU <br /> oom <br /> Item emperature <br /> wl <br /> --�_ <br /> Food Safety Certification Facility Hot Water Temperature ` <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> ( ) <br /> EH Specialist: Phone: <br /> Time in: Time Out: 1 Page 30 <br /> EHD 16-24(21d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />