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♦ POUIN <br /> ?° C,o� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C��iFOR�j;P Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> � <br /> Address: ` 7 Zip Code: <br /> /J /rte <br /> Owner/Operator: ✓ Telephone: <br /> Program Element: j Program Record: 30_'=, Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> !i i'c ami <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm 11 Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: —� <br /> EH Spe ilist: P h o e:��% <br /> Time in: Time Out:� Pagf <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />