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0fi6k411N., F SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c�;•.. = r ;� . Telephone: (209)468-3420 Fax: (209)464-0138 Web:v,+ww.s[gov.orglehd <br /> C1 Fd'RN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i " 1✓ Date: 7 To T717 <br /> Address: L�� 1 ,� o +� / City: Zip Code: <br /> Owner/Operator: 1 `t{ Telephone: <br /> Program Element: Cl Program Record: O f Inspection Type: r,� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: GV`C <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Lodi <br /> ot <br /> AGL a <br /> r" 0 V A czd t avOt ►-. <br /> ti Ice D <br /> 1 l.� <br /> IemlLocation Temperatur.e Item 1 Locatj �. Temperature <br /> __. 2 :. . .. . <br /> i <br /> Food.Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: "F uat.Amm.: ppm 10ther: 'F <br /> Received By I Title: n <br /> EH Specialist: 'T /1�1 11�� Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2r1 pg) 03113 FOOD PROGRAM OAR CONTINUATION <br />