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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •'64�i d'AN�a. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.orcI/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -L Date: I <br /> Address: M C_, _ City: n-_ Zip Code: <br /> Owner/Operator: dCN 0 �a� Y/ Telephone: <br /> Program Element: Program Record: Z i Inspection Type: <br /> SB180 Posted Yes No Permit Posted No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS' <br /> I <br /> S <br /> � 1 <br /> c <br /> G <br /> o F G'Pd� <br /> %A�kCAM C, <br /> NW11AI�— <br /> s G;6 <br /> J v.' ci rAr44@zA0 CVvvl ' <br /> vN <br /> (A/ 4rj <br /> t <br /> ItemlLo�1catitton Tem erature Item I-Location Temperature <br /> ma It <br /> C <br /> Food;Safety.Certification Facility Hot Water Temperature _ - W_arewashhig' <br /> Name: Hand Sink: W OF Chlorine: 1ppm Heat: OF] <br /> Exp.Date: arewashing Sink: f of Quat.Amm.: ppm IP ther: of <br /> I <br /> eceived By I Title: VIV IQeH Specialist: P ne: i1✓ cl <br /> a LlJ 4 _l <br /> ime in: Time Out: Page of <br /> EHD16-24 (2^dpg) 413/13 FOOD PROGRAM OR CONTINUATION <br />