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o.RAu''"• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />" 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.si.gov.org/ehd <br />�FOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />l <br />—� <br />Date:jF,;, <br />Address: <br />City: <br />t,4 .1 I Zip Code: <br />/u L,� <br />OwnerlOperat r. <br />_ f� <br />Telephone: <br />Program Element <br />Pro <br />o <br />m Record: y/ L < <br />a <br />Inspection Type: <br />8180 Posted <br />❑ Yes 11 Permit Posted ❑ es ❑ f <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />¢mlL.ocatiory _ <br />1 m <br />I Temperature <br />(. F <br />- Item t Location <br />✓Gt oL Y(',jjtijyh, jL <br />Temperate .; <br />jou <br />Ir— <br />l02 <br />Name: <br />/'h„ 1101 <br />co <br />�- Facility Hot Water Temperature <br />and Sink __. ._.. <br />of <br />Warewasbing <br />Chlorine: _. ppm Heat <br />Quat. Amm.: ppm Other <br />_ . "F <br />'IF <br />Exp. Date: Z arewashing Sink: -- aF <br />Received By I Title: <br />EH Specialist: <br />% ` <br />Phone: (f /I <br />I % <br />Time in: r/ <br />Time Out <br />1111 <br />pager Z <br />EHD 1624 (2° pg) 413113 FOOD PROGRAM OR CONTINUATION <br />