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------------------- <br /> SAN <br /> '-----------SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I Date: 0' <br /> Address: I City: Zip Code: ^Z <br /> Owner/Operator: o e: '72-,./�� <br /> Program Element: Progr Record: Inspe tion Type: JJ <br /> 6180 Posted 0 Yes G o Permit Posted 0 Yes G No Re-Inspection on or After: <br /> T . "..ossERVATIONS AND'CORRECTIVE ACTIONS ' ', <br /> 1 <br /> -� � <br /> IternA wition Tempmature item!Location ' Temperature_ . Item I Location Temperature <br /> o�J — 7`F 4(/OP <br /> aF <br /> Food Safety Certification Facility HotW8WT8mperature Warewashing <br /> Name: Hand Sink: PPM Heat: ep <br /> Exp.Date: arewashing Sink: Z =F uat.Amm.: V ppm Other: of <br /> Received By/Title: /1, ' <br /> EH Specialist: Phon : <br /> Time in: Time Out: /�%�(O Pageof 4 <br /> EHD 1613(2e pa) 0729169 FOOD PROGRAM,OR CONTINUATION <br />