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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Q: a <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />c... `P.. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />9C%PORN <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />1 !) <br />1 <br />Date: I 7-f-2 i <br />Address: <br />t t <br />I S City: <br />G CM <br />Zip Code:Cl <br />Owner/Operator: <br />nNil.! <br />O,( ,OS <br />Telephone: <br />Program Element: I <br />Program Record: & lY 01 n <br />Inspection Type: <br />SB180 Posted Yes <br />Nd <br />Permit Posted Yes , No <br />Re -Inspection on or After: <br />SERVATIONS AND CORRECTIVE ACTIONS <br />4 POT <br />Dt, 1c) <br />7W5 <br />peonui� <br />ovation <br />- <br />empereture- <br />- <br />tura <br />Mood Safety Certitica <br />Facility Hot Water Temperature <br />Hand Sink: <br />-F <br />lorine: <br />Warewashing <br />ppm Heat: �F <br />ame: <br />Exp. Date: � <br />arewashing Sink: <br />-F <br />Pat.Amm.: <br />ppm Other: �F <br />Recelved By /Title: <br />EH Specialist: <br />Phone: <br />l v <br />me in: kj <br />Time Out: <br />Page of <br />EHD 16-24 (2n°pg) 4013 FOOD PROGRAM DIP CONTINUATION <br />