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4 1N 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.sogov.ora/ehd <br />9GlFO H� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />4 r� /• P r t` <br />' u a Date: <br />7bZ <br />Address: <br />Jo �� <br />C Zip Code: <br />Owner/Operator: <br />r <br />Telephone: <br />Program Element: <br />Program Record: /J ,b / -33 Inspection Type: <br />_ <br />B180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: ZS <br />�LOZ3 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />hywe blfaz2 Aada <br />lop/ <br />orf / <br />( J 0 <br />/I <br />re tL7a� <br />L <br />e r <br />r <br />Item/Locat on- <br />Temperature <br />Item / Location <br />Temperature <br />Food <br />Safety Certification Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />'F <br />Chlorine: PPM Heat: <br />-F <br />Exp. Date: <br />arewashing Sink: <br />`F <br />Oust. Amm.: PPM that: <br />.F <br />Received By/ Title: <br />EH Specialist: <br />— <br />hone: <br />Time In: I I'. <br />S /1 <br />Time Out: �o <br />Page of <br />H{U 16-24 (2m PJ) 413113 F000 PROGRAM OIR CONTINUATION <br />