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SAN JOAQUIN CO TY <br /> r. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c4.,... ,.a a• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siciov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Una Date: 0_- _' <br /> Address: D f'Yl�i City. Zip Code: 5 33 <br /> Owner/Operator ( ' Telephone: I -Z Z <br /> Program Element: l�0 rogram Rec rd: P �3 Inspection Type: m �-� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> - -__ OBSERVATIONS AND CORRECTIVE ACTIONS <br /> !i r -- <br /> �a nor a <br /> - c-o r <br /> Itemll.ocativn :Temperature item Locatigga <br /> Food Safety Certification Facility Hot Water Temperature War' <br /> Name: Hand Sink: F (Chlorine: ppm Beat: OF <br /> Exp. Date: Warewashing Sink: 'F Gluat.Amm.: ppm Other. OF <br /> Received By/Title: <br /> EH Specialist: Phone: 953- .� <br /> Time in: Time Out: 7 Page of <br /> EHD 16.24 (2m pg) 41,N13 FOOD PROGHAM OIH CONTINUATION <br />