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QP�u'lN•.,C `.. SAN JOAQUIN COUieY <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �..• 2 :P Telephone:(209) 468-3420 Fax( 209)464-0138 Web:www.sigov.orc7/ehd <br /> 4L%FOA? <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: . ; Date: <br /> Address: -), Ce ✓!C�✓ City: ` ` Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: , Inspection Type: <br /> SBi80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: w <br /> OBSERVAM§Q AND CORRECTIVE.ACTIONS <br /> jav- <br /> -- k <br /> od <br /> w�v� --- <br /> e-�r,�;� <br /> ':1 us-r ly C <br /> Item/Location T emperature Item 1 Location ., TTemperature <br /> V1J t Chia-e ��' Zl LV <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ — = ---- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time( u : / Page'�of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR C06TINUATION <br />