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SAN JOAQUIN COUNTY <br /> x°�U' 'o� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www,si.qov.org/ehd <br /> - <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — Date: 5- Z V <br /> Address: `k r City: / n_1 Zip Code: <br /> caner/Operator: ��f Telephone: <br /> Program Element: iv Program Record: PRO—C 6)I fr'7 Inspection Type: 7—eiel <br /> B180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND Cr RRECTIVE ACTIONS - <br /> 1010 <br /> qj <br /> ZPjo1 a <br /> JL vizr <br /> r fw <br /> At L. ZQAP <br /> 1 J b Z"-1 <br /> 4 ` fn m 4el itue <br /> Gi <br /> LJ s [t L ' l SAd j�. <br /> don tA^ mCA At <br /> {/ 41!2 <br /> Temperaiture item!Location [Temperature <br /> LL_ Faci ty Hot Water Temperature arewashing <br /> Name: Hand Sink: of hlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: of uaL Amm.: ppm her: -F <br /> Received By/Title: <br /> EH Specialist: o `1 Phone: / r 7Q,5z <br /> me in: k' �/� Time Out: J PageZof 2— <br /> EHD 16-24 (21°pg) 4W3 V F00D PROGRAM OIR CONTINUATION <br />