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4uln- SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ddb/Fd,Q�;;e Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:- I <br />e Date: <br />Z <br />ddress: <br />City. Z Zip Code: <br />r _ <br />2l <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program <br />Record: D Z Inspection Type: <br />e/ <br />Set 80 Posted Yes No Permit Posted Yes No Re -inspection on or After: <br />- <br />BSERV TIONS AND CORRECTIVE ACTIONS , <br />a on S <br />A VP1 <br />O <br />UA rte <br />co4r h <br />c S �Yl <br />e r kvi (k-" <br />On U a neo r <br />o- <br />c —0. <br />✓l zoomkis <br />kp� ✓ , <br />S /^a. c,�, tiS ee- <br />e P_ <br />S e tri i a'l/i7 1L0 <br />i Le _ <br />✓ oo <br />GAN <br />i <br />45 <br />iso- �n /Qc <br />- Item / Locati '' <br />`° rature <br />' ItemiCocatlon 'MorTTemperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing._ <br />Chlorine: ppm Heat: <br />aF <br />Name: <br />Hand Sink: F <br />Narewashing Sink: 'F <br />Exp. Date: <br />uat. Amm.: ppm <br />Other: <br />of <br />Received By/ Title: _ �$CL�-S S'� <br />Ol✓ til <br />EH Specialist:/ a -Dri� <br />hon : <br />Ime In: t I _ ?)c9 AM <br />Time Out: 12 I IJ <br />Page of <br />EHD 16-24 (2n0 pg) 4W3 FOOD PROGRAM OIR CONTINUATION <br />3 <br />