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A4rN SAN JOAQUIN COUNT <br /> ao'�a Qo� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c;�lPda`'�P• <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s6gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone/ / <br /> Program Element: �/7 Program Record: Inspection Type: <br /> SB180 Posted Z_Y4§ No Permit Posted ,,yRs No Re-Inspection on or Aker: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> exnx <br /> ter' <br /> % { <br /> >i <br /> pe -3y <br /> o o� <br /> Item/Location Temperature Item/Location , <br /> 9 <br /> Food Safety Certification F Facility Hot Water Temperature <br /> Name: // Hand Sink. '.._ ChlonrJ€: eat: F <br /> F PPM <br /> Exp. Date: Warewashing Sink:�OO "F (]uat Amm.: PPM er: .F <br /> Received By/Title: <br /> EH Specialist: 2 Phone: 74�J7S� <br /> ime in: �a,•30 Time Out: �.� Pe f <br /> EHD 1624 (2m pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />