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SAN JOAQUIN COUN', <br /> P _ <br /> P` y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 6�.,. Telephone: (209) 468-3420 Fax: {249)464-0138 Web:www.slgov.orglehd <br /> <<FOA <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: •- t(V- Date: <br /> Address: S_ ! V 1 P r I City: Zip Code: <br /> Owner/Operator: i V r (� G� Telephone: <br /> Program Element: !e� Program Record: ovt Inspection Type: <br /> SB180 Posted �f Q Yes la hermit Posted F-Yes Of Re-Inspection on or Aker: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> `' 1LLf ] _ <br /> - <br /> �i 4, <br /> 13 <br /> C~ k S - aA 6AAjt t <br /> G <br /> r <br /> IV <br /> I>, <br /> yVIN <br /> K <br /> S1 Nif U Wi Wttk vZ9 c jyy2S v1-e4l <br /> ItemlLocaf oii' Temperature --ftriiTL`" on _-,_- __-_ ._.. Temperature <br /> 77v <br /> . ood Safety CertificationEFacnit Not Water Temperature Warewashing <br /> Name: ofChlorine: ppIn Heat: °F <br /> Exp.Date: ng Sink: aF Quat.Amm.: pprn Other: °F <br /> Received By!Title: To <br /> EH Specialist: Phone: fl�pt— <br /> Gf�1rt� <br /> Time in: Pr <br /> t Time Out: Page�of <br /> c <br /> EHO 16-24 (2^ pg) 4.13113 FOOD PROGRAM OIR CONTINUATION <br />