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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siqov.orq/ehd <br /> c4�i R a'a��p <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Faciiity: a Gy Date: J <br /> Address: d� City: ' , Zip Code: 0 <br /> Owner/Operator: Telephone: <br /> Program Element: & Program Record: coln Inspection Type: <br /> 5Bi89 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVATIONS AN CORRECTIVE ACTIONS <br /> w Iwo ' <br /> Poo <br /> C ,,, 04 d4ld 4,AxA —lire <br /> c In' o S \ �A4 � o ' �0C .'.b <br /> i <br /> cf "OW <br /> item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: 'F Chlorine: ppm Heat: F <br /> Exp.Date: arewashing Sink: °F Quat.Amm.: ppm ther: "F <br /> Received By/Titl <br /> EH Specialist: *' 1 v�Phone: <br /> Time in: !toy aw-1 <br /> Time Out: O.-� Page lof <br /> 1 <br /> 19 li <br /> EHD 16.24 (211 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> l <br />