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aP4{lN• o SAN JOAQUIN COUNTY <br />A' r <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•.c4., .�;ca Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: - <br />i ���L <br />/�,pr� <br />Date: <br />Address: I -�1.0 <br />City. S L p Al Zlp Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />6 O <br />Inspection Type: <br />58180 Posted( Y <br />No Permit Posted <br />Y No <br />Reinspection on or After: <br />vP <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />ok-75- /o" c C , t� <br />O✓ 7 <br />i A. <br />S•'�� ovI t Lra <br />�� =� <br />oSt a /`l9 <br />W <br />a� <br />S <br />S .e l I <br />e <br />e4 <br />o sE;e„�-- a/, <br />,. lig✓ `i a <br />�n ce it n <br />�Ze <br />owl <br />✓vrii e- to <br />Item/Location <br />Temperature <br />Lno 16 <br />it <br />V&7 P <br />��ca �o s_a <br />Food safety Certification <br />Facllity Hot Water Temperature <br />- Warawashing <br />Chlorine: ppm Heat: of <br />Name: <br />Hand Sink: I OL) <br />ll <br />of <br />Exp. Date: <br />.L! <br />arewashing Sink: l <br />t <br />-F <br />ouat. Amm.: ppm <br />Other: o f <br />Received By/ Title: <br />TS `ua <br />✓ W O <br />EH Specialist: <br />^� <br />Phone: i� A 6 / _ 3 L) 3 S <br />o� <br />[me in: '7 <br />!J Z <br />Z Page of <br />Time Out: I 'i (4 O <br />EHD 16-24 (2n° pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />