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SAN JOAQUIN COUN7 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4�iiii3W <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.or./c� ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: Z ZZ <br /> ddress: C �c7 _ City: Zip Code: <br /> OwnerlOperator; D 0 Telephone: <br /> Program Element: J Program Record: ��� c Inspection Type:. v� <br /> B160 Posted l O Yes ❑ Permit Posted D Yes ❑ IJ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l <br /> W <br /> iDP M v,. <br /> o— 7 <br /> --� e <br /> Q <br /> V <br /> yQ / �d - <br /> ItemlLocaEion l._T peratu a item 1 Location = Tem <br /> Cation Eacility Hot aterTemperature Warewashing — <br /> _ _ _ . W,Y <br /> Name: Hand Sink: oP Chlorine: PI Heat <br /> III Date: Warewashing Sink. of uat.Amm.. T Ppm I Other: �H <br /> I <br /> Received By!Title: ' <br /> H Specialist: Phone: <br /> Time Out: n r -3 Page of <br /> EHD 16-24 (21 Pg) 413113 v FOOD PROGRAM O1R CONTINUATION <br />