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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•cq., a ,�;< Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.oro/ehd <br />�FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />-z2 7 <br />ddress:City: <br />! h Zip Code: <br />Z <br />Owner/Operator: <br />Telephone: <br />Program Element: I <br />Program Record: rf6O <br />Inspection Type: <br />Set 80 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />tn,• / e A: <br />e r <br />l�C <br />ash <br />/a <br />b4 < <br />0 Wr � /t -o //d N • <br />INIsLla <br />i <br />A . <br />Item/Location <br />- <br />MEOWItem <br />/ Locatlon <br />Temperature <br />Food Safety Certification 'Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of hiorine: PPM Heat: <br />`F <br />Exp. Date: <br />arewashing Sink: <br />ther: <br />of uat. Amm.: Ppm r <br />of <br />Recelved By/Title:� <br />-L <br />Q �� �/ <br />'I <br />d <br />EH Specialist: <br />phr <br />Phone: <br />ime In: - .6 <br />Tlme Out: �; <br />Page of <br />BID 16-24 (2- P9) 4P 13 FOOD PROGRAM OR CONTINUATION <br />