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o Qul" o SAN JOAQUIN COUIY f•Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Wr :{ <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c F Telephone: (209) 468-3420 Fax: (209)464-0.138 Web:www.sogov.org/ehd <br /> 4tiFo�a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ro <br /> ', U r)-L J&-� I F� Date: I0_ J -16 <br /> Address: City: Zip Code: <br /> Y1'1�3 r! e:r <br /> Owner/Operator: %, ` /Ve f-mQ Imo- Telephone: <br /> Program Element: C� Program Record: r7 rl Q- Inspection Types <br /> S13180 Posted Yes No Permit Posted Yes No J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 11 [Yla r i a h s cu rQ 1 r'e +__s - <br /> Cz n o .s <br /> & . <br /> a <br /> Item/Location perature Item f Location temperature <br /> -- - --- <br /> road Safety Certification Facility Hat Water Temperature arewashing _ <br /> Name: (Hand Sink: F Chlorine: ppm Heat: F <br /> Exp. Date: arewashing Sink: „F Quat.Amm.: ppm Other: °F <br /> Received By 1 Title: <br /> EH Specialist: Phone: `16 �-7 +� <br /> `1 <br /> Time in: 0Time Out: In Pagez of.� <br /> EHD 16-24 (2n°pg) 41&13 FOOD PROGRAM 01R CONTINUATION <br />