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ot+4u1N'•.c SAN .JOAQUIN COUNTY <br /> 1��•A <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •'cq., F ��e•.• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sogov.ora/ehd <br /> �IaoA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: M� <br /> Address: () mC-anN G 0 � City: Zip Code: r <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: 5Z/_ r 1 I Inspection Type: <br /> 6180 Posted es No Permit Posted a No Re-Inspection on or After: <br /> .- -- - --- a — - - — ate---=• --s> <br /> I OBSERVATIONS AND CORRECTIVE ACTIONS <br /> V4)1W i 1 <br /> U db z� <br /> Item/Location -.Temperature - Item lr Location x iTemperature' <br /> �. <br /> Edodf5afety,6ertflcatlon _I- Facility Hot Water Temperature _ _Warewas Ing. <br /> Name: Hand Sink: "F Chlorine: PPM Heat: IF-] <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: PPM Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: _ ([�.— 3L1?rj <br /> Time in: Time Out: V Page of <br /> EHD 16-24 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />