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SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> UK <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> LIFO'Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i,� Date: _ I <br /> Address: City: C / ` Zip Code: }L <br /> Owner/Operator: Telephone: <br /> Program Element: L p Program Record: n.5 Inspection Type: <br /> 6180 Posted Yes ❑ Permit Posted s ❑t Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a�� s <br /> 2 I L fir- C IqNa- <br /> W44er a4t2r4-odqV. <br /> Item/Location tern Location Temperature <br /> aeon Facility <br /> Hot Water Temperature Warewashing <br /> Name: _1 Ea <br /> d Sink: �I 0 of (Chlorine: ppm (Heat: of <br /> Ex Date: was lJ p � 0 g Sink: of Quat.Amm.: ppm /Other. F <br /> Received By!T <br /> EH Specialist: / Phone: <br /> Time in: ` ,� Y�(/y Time Out: �1 L( PageZof <br /> EHD 16-24 (2n1 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />