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A " SAN JOAQUIN COUNTY <br /> �4�•£Po <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: [ <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:WWW.sioov.org/ehd <br /> 4�iPOP� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: K <br /> Date: <br /> Address: \ City: Zip Code: OI 5 <br /> Owner/Operator: \ ��A /� ; Telephone: <br /> Program Element: \ t--1Program Record: b 1 21 Inspection Type: ` <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> AL OBSERVATIONS AND CORRECTIVE ACTIONS <br /> W/,-N A 3 <br /> c (91 <br /> by Q39 yO m s' \'Z�F <br /> C 39 <br /> Item/LocatioernperatureitemlLocation , ° 'Temperature <br /> k142 L 4 - <br /> IS - k - ,n 141 - <br /> Q3c� tie d t\r-2r ,,j04 tiOt= <br /> Facility Hot Water Temperature Warery",- <br /> Name: G Hand Sink: `v of Chlorine: ppm Heat: =p <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: =F <br /> to- 25- 2 12 <br /> Received By/Title: N, 77 <br /> EH Specialist: Phone: 'Z`'�_ t0 11,— JI�ZS <br /> ime in: Time Out: I ! q Pages-,of 2 <br /> 2. 1 -- <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 IV pg) 4013 <br />