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f <br />peaum• SAN JOAQUIN COUNTY <br />g: � ••.ate <br />a' ?� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•••c... �a•Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />9�I FbR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Q4 <br />S Q O ✓I <br />Date <br />Address: <br />Z -ZO 3 <br />I ' _ G <br />L <br />City: <br />Zip O Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record:S po 6 S 6 <br />Inspection Type: <br />Set SO Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />3I- <br />o ' <br />s <br />t S S <br />;SSS117 <br />6Co 2 <br />S;h <br />a G ocvv <br />1 19 <br />0I, - <br />(u <br />A7 P� <br />L2— <br />yy <br />/eC7n' I7 v <br />SKS <br />Item/Location' <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />F Hot WaterTemperature <br />Warewashing <br />Name: <br />-clllty <br />Hand Sink: <br />eF <br />hlorine: ppmeat: <br />of <br />Exp. Date: <br />wewashing Sink: <br />.F <br />uaL Amin.: ppm <br />they: aF <br />ceived By/ Title: iS S <br />I- Q <br />P In <br />Specialist: - <br />l� <br />[E,'H <br />D <br />� <br />Phone: <br />In: <br />Time Out: <br />nme <br />. 3 T' M <br />� Page of <br />EHD 1624 (2d pg) 4W13 FOOD PROGRAM OIR CONTINUATION <br />