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SAN JOAQUIN COUA <br /> Q` �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209 468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd <br /> �lFOR d� 1f}w��, ILI <br /> ROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -0 AA6G (,0C " Date: rtj <br /> Address: t�jCity. Zip( <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted s ❑ Permit Posted t ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS94A V1 b <br /> . <br /> r � <br /> Q C <br /> n <br /> •moi, � <br /> .,A <br /> o6isi <br /> {�U " I1 <br /> RR <br /> Iej � <br /> r ? f-5 <br /> R �' <br /> 00 <br /> © ( 6 <br /> 10 C 44A <br /> O'l/ o q <br /> ( C <br /> 16 <br /> 2 DJ>S ; <br /> ' M <br /> 1 <br /> J <br /> C �- .........-. , ,. <br /> irri !Lo titian Te , rature <br /> lte ation �emperetttre — _ <br /> J. <br /> FCert i tion FacilityWater?ernperature Warewashing <br /> __. <br /> Name: r Hand-Sink. of [Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm <br /> 'Other: F <br /> Received By/Title: h S <br /> EH Specialist: <br /> EH Specialist: Phone:' <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2-pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />