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oPQu'y. SAN JOAQUIN COUNT Y <br /> x� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c.., ;P• Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.si4ov.orglehd <br /> 4LlF�.R� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> t <br /> Address: � C City: Zip Code: <br /> OwnerlOperator: C Y R- Telephone: <br /> Program Element: 1 1 0� Program Record: 4S �� ; s Inspection Type: <br /> SB180 Posted ❑Yes 11 No Permit Posted 17 Yes No Re-Inspection on or After: <br /> OBSE 1RVATIONS AND CORRECTWE ACTION <br /> J L Q 2 <br /> rZ ' <br /> 42 <br /> 5 l <br /> - 1 <br /> ItemlLocation Temperature Item 1 Location" T erature ;' Item 1 Location "" t1 <br /> F�j kO&T *t=Fyy,Gertification Facility Hot Water.Temperature'' ° Warewashing _ <br /> Name: Hand Sink: aF Chlorine: ppm Heat: 9F <br /> Exp.Date: Warewashing Sink: OF uat.Amm.: ppm Other: of <br /> Received By!Title: �i ' "C E� d <br /> EH Specialis Phone: _ 2�Cl - �1 b -- <br /> ime in: ► \ Time Out: Page% 04 <br /> FHD 16-24 (2"pg) 4l9;12 �) FOOD PROGRAM OIR CONTINUATION <br />