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SAN JOAQUIN CO' TY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.or /q ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U � Date: <br /> .S <br /> Address: rn� City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: �y Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No o v Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --.-._... --- o <br /> `via <br /> ,en z , �k t vuv �oV>-"_yL <br /> Item/Location Temperature I Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature �l Warewashing <br /> Name: Hand Sink: F Chlorine: ppm (Heat: F <br /> Exp.Date: Warewashing Sink: F Quat.Amm . ppm Other: of <br /> Received By/Title: <br /> XA <br /> EH Specialist: Phone: <br /> Time in: r Time Out: Pag of <br /> EHD 16-24 (2^d pg) 4/3113 FOOD PROGRAM OIR CONTI 'UATION <br />