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PQu�" SAN .JOAQUIN COU, f <br /> 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: a <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•. :P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> �ii:i6' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S Date: <br /> Address: ` Z� Po-c,.! �G City: C+0^4, ,�,,,, Zip Code: 95— <br /> .107 <br /> Owner/Operator: <br /> 5— <br /> Owner/Operator: r L�l; Fe ri 5 t, �'I`-rt v t Telephone: 59_ <br /> Program Element: 4,000Program Record: CObt'3 q I.Z Inspection Type: o fvkv <br /> (Q•�rl-� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> QBSERVA I{?NS Ai+l©C913RECTIVE,ACTIUNS <br /> __.. iC h.� _____--✓` II w�na Ck r•e cc 1' a`F'�'1"o►'Yl c�r <br /> - --.._..._..--..............-- — - ----.........__.._........................._..- <br /> .__....................._ <br /> c.�_......... r <br /> �-I-�.p✓ Ce <br /> r -e �C - Ut a r, i <br /> ` I m G 1 eirt cXa--d <br /> (t)i6 S i f nn. )"-e s - _—___--- <br /> ItemlLocatior emperature ,` ', Item i Location s Temperature <br /> . - - <br /> Food Safe Certif�cat�on v a girty H tWater temperature VYarewashing <br /> Safety _._ti.., - ,r. �. .. ��... <br /> Name: Hand Sink: of Chlorine: ppm Heat: -F <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: `�, '_ 1 / Phone: D 963' <br /> 3 1-� ----- <br /> Time in: I; IO Time Out: Ji Page•Aof <br /> EHD 16.24 (20°pg)4/3113 FOOD PROGRAM OIR CONTINUATION <br />