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0�4"'" F SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4•., r �;; Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s' ov.or /ehd <br /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r- trC A� p��� /71/ f— — date: <br /> Address: 4C r o a/V!t AVECity: Z , i Zip Code: <br /> Owner/Operator: FTelephone: <br /> Program Element: 16 D Program Record: �, C r spection Type: Al EVF� <br /> [S—Bl—EIOPosted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONSi at <br /> rw� <br /> „io k')jo'lp 1;U/9' s <br /> a a� <br /> Temperature Item 1 Location emperatu, <br /> Food Safety Certification Facility Hot Water Temperature Warewashing _v <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date. arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By 1 TR1 1 <br /> EH Specialist: Phone: �1 _ 5 / r <br /> Time in: _T i l ¢ y� h p �,� Time Out:f- C� Pag of <br /> J � 1/ Y <br /> EHD 16-24 {21d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />