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anAuin. SAN JOAQUIN COUNTY <br />a ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�dclFsR�,a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: 4/11122 <br />23 <br />Address: <br />fV <br />�� (/l� <br />City: � ZIp Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />a b <br />Z_ Inspection Type: a <br />6180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />mi �r <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />oVel� <br />Ccw `C <br />C <br />— D S <br />✓e <br />QS <br />o- <br />aG Q <br />t>, <br />!•e <br />/ e DJ / ,i Glc <br />C r4.A-- <br />GSL <br />4e L <br />cno ti <br />/A r <br />L� s• <br />I <br />re <br />ItendL <br />Temperature <br />� Item / Location <br />Food Safety certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />=F <br />(Chlorine: ppm <br />t]uat. Amm.: ppm <br />Heat: <br />,F <br />Exp. Date: <br />arewashing Sink: .F <br />Other: <br />'F <br />Received By / Title: rD <br />Y 7o-y� <br />EH Specialist <br />"(--, <br />Phone: <br />Time in: 12 ;Z <br />M <br />Time Out: <br />Page of <br />EHD 16-24 (2'^ pg) 4013 FOOD PROGRAM OR CONTINUATION <br />