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opQ� N SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DE ARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> kbi~ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddresw city: Zip Code: <br /> caner/Operator: - <br /> /� Telephone �9'y> <br /> Program Element: Program ecord: Inspection Type: r <br /> 8780 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> RVATIONS AND CORRECTIVE ACTIONS <br /> ftem/Locatlon Temperature Item l Loca r <br /> _Food Safety Certification .�acdity Hot Water Temperature _ _- - Warewashmg <br /> Name: Hand Sink: ,F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: =F Ouat. Amm.: ppm Other: eF <br /> Received By/Titl k V Q <br /> EH Speciali Pho <br /> Time in: ��. Time Out: d-�� Pa30 <br /> 9e/of <br /> EHD 1624 (2n°pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />