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OF <br />Sq.PA ln�.,9p SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�4c/Fd#Y;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.orD/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: —''-'' — Z <br />Address: -4 2 1 C Q <br />` City: Zip Code: `V <br />S 2 <br />Owner/Operator: <br />Telephone: <br />Program Element: 1 1 _ 2l 1 Program <br />`1 <br />Record: S O^ •2 bO Inspection Type: <br />`-J <br />SB180 Posted Yes No Permit Posted Yes No Re -Inspection on or After: <br />EWMk <br />CIOZ u <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />\C ,4 � L 'F n c- <br />{ <br />; < <br />IL <br />s' <br />d <br />2 <br />C� r --P- pr or 7K� <br />3 <br />1 - <br />-- CALZ <br />a� <br />0 <br />/MLocatlo._ <br />—rte free <br />C^ <br />Name: <br />Exp. Date: <br />�f. Temperature tem Location Temperature <br />Facility Hot iWor Temperature erewashing <br />Hand Sink: Chlorine: ppm Heat: =.F <br />arewashing Sink: - �� — 'F Quat. Amm. FE*�, ppm 11 Other: =F <br />ecelved By / TNIe. ^T Specials vPhone: <br />[,H <br />'ZOOI_ blb_ 32L] <br />me In: 1Z+ <br />Time Out:529 S <br />n. <br />EHD 16-24(2n0 pg) 41313 I - FOOD rnvannm vin vvi.�i�.v�iiv. <br />X12051-�1i�g S <br />