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4k1"•• SAN JOAQUIN COUNTY <br />aa�'sn� <br />?� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�gciFapatr. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT j <br />Name of Facility: <br />Date: 7 <br />ddress: '>, <br />v 0 <br />City: <br />Zip Code: <br />Owner/Operator: <br />Li <br />Telephone.'1 <br />Program Element: <br />Program Record: <br />Inspection Type: <br />!/ <br />8180 Posted Yes No <br />Permit Posted YeS7 No <br />Re -Inspection on or After: <br />a- <br />OBSERVATIONS AND CORRECTIVE AtGTIONS <br />'IhAj 11 t <br />11dA4A1Rk_- <br />7 <br />.f <br />n <br />[IXP-60 <br />�/� <br />l <br />r <br />C <br />I 11-1alt <br />Irk <br />awf <br />j- <br />Ir <br />3 ead� <br />yvvo <br />'^• <br />G wtkt r <br />S t a� Gt tvw_ <br />U <br />(t <br />D <br />omit S <br />3 <br />eio'' <br />rattYre' <br />l� t� <br />,eIMF <br />_ -' Foody <br />Name: <br />MEO^" <br />0 <br />Fa llity Hot Water Temperature <br />Hantl Sink: of Chlorine: <br />Warewashing <br />ppm Heat: <br />eF <br />Exp. Date: <br />'Warewashing <br />Sink: <br />oP <br />Ouat. Amm.: <br />ppm <br />Other: <br />of <br />Received By/ Title: <br />EH Specialist: 1> <br />-Z— <br />Phone: I -O <br />- t <br />V <br />Time in: <br />Time Out: <br />PagTf I <br />EHD 1624 (2w pg) 413/13 FOOD PROGRAM 018 CONTINUATION <br />