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SAN JOAQUIN COUN'. <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> �%FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r- Date: ��7 <br /> ddress: r City: Zip Code: <br /> Owner/Operator: Telephone: V <br /> Program Element: &4 <br /> Program Record: �- Inspection Type: l^ <br /> SB180 Posted F Yes F, Rermit Posted G Yes f I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L <br /> a, <br /> (� Safety <br /> y Q r l I y._.. Water p r_�_o f � _.-Ware shing -- <br /> Name , /� V Hand Sink: — Chlorine: _- Heat: F <br /> Food Saf Certification Fac�lit Hot Water Tem erature Warewa <br /> Exp.Date: arewashmg Sink: of Quat.Amm.: pp�n (Other: F <br /> Received By/Title: . C� c' C� } <br /> EH Specialist: r l Phone: Sr '77 3,-5- <br /> Time in: Time Out: ' Page of <br /> EHD 16-24 (2^'pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />