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,�� •r, SAN JOAQUIN COUNTY <br /> 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 /> 'PCI a iSt1�\ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ``• ,. �1- Date: l <br /> ddress:.-� `• L� / ` City: �, Zip Code: <br /> Owner! perator: �� /�L� Telephone: <br /> Program Element: Program Record: L�--� Inspection Type: <br /> SB180 Posted Yes Permit Poste Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONSAAAWL <br /> AAC <br /> Item/Location Temperature Item I Location YTemperature <br /> I <br /> Food Safety Certification _ Facility H_ot_.Water Temperature Warewashing _ <br /> Name: �nd Sink: "F hlorine: ppm Heat: OF <br /> Exp.Date: rewashing Sink: of uat.Amm.: ppm Other: 'F <br /> Received By I Title: . U 1 !_ <br /> EH Specialist: ✓ ' !Phone: <br /> e <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2o0 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />