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SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ... �p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> 4�;FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` Date: i 'Z - 3- <br /> Cl <br /> Address: �y Y 11 City: CQ` Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: b2 Program Record: i l_ OOH21 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No `U Re-Inspection on or After: <br /> OBSERVATIONS AND.CORRECTIVE ACTIONS <br /> 12 <br /> ` <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot'Water Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: °F <br /> Received By/Title: (" <br /> EH Specialist: Phone: <br /> Time in: ` ` Time Out: _S' 1 . ICJ Page'of / <br /> S- <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />