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SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:wv�nv.sia.ov.orq/ehd <br /> �iFpsici <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -7 1- Date: �/ <br /> Address: City: Zip Code: <br /> Owner/Operator:HTelephone:��� 7 <br /> r <br /> Program Element: Pr gram Record: O Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> -s OBSERVATIONS AND CORRECTIVE,ACTIONS <br /> 7� r <br /> 7 <br /> 0, <br /> n — --- <br /> Ifemm/Location ' Teerature <br /> P Item/Location 1 Tempetature <br /> Food Safety Certification Facility Hot Water Tem erature <br /> — —— __.:.:_:___ Warewashing <br /> Name: Hand Sink. of Chlorine: Heat: <br /> Ppm °F <br /> Exp.Date: ewashing Sink: of Quat.Amm.: ppm iOther: of <br /> Received By/Title: / v <br /> EH Specialist: ✓` 47 b UC <br /> Phone: <br /> Time in: �U ./ Time Out: Page f <br /> fo: fid' <br /> EHD1G-24 (2n0pg) 4013 <br /> FOOD PROGRAM OR CONTINUATION <br />