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of`��`" SAN �JOAQUIN COUN <br /> �.� o� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.. a w a Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.orglehd <br /> LlFOk <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 77 <br /> Date: /67 , <br /> Address: City: Zip Code: <br /> caner/Operat Telephone: <br /> Program Element: f q Program Record: 00-3 Z Inspection Type:IS <br /> 9180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 9�2Yx r <br /> Y•IA ' <br /> e (' ,,I <br /> � c <br /> a <br /> 5 f <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: hand Sink: of Chlorine: PPm Heat: of <br /> Exp.Dat Warewashing Sink: eF uat.Amm.: ppm Other: of <br /> Received By/ <br /> EH specialist: Phone: <br /> ime in: 3 n Time Out: •D ,3O J7 Page 1 of Z <br /> EHD I6r24 (2w pg) 473113 d FOOD PROGRAM OIR CONTINUATION <br />