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SAN JOAQUIN COUK <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �,�%FC\tY�p• Telephone:(209) 468-3420 Fax:(209) 464-0138 web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: %I Date: <br /> Address: <br /> 6" City: Zip Code: 7 <br /> caner/Operator: - , Telephone: /7 — <br /> Program Element: — Program Record: Inspection Type: ,�j p c V <br /> B180 Posted Ve No Permit Posted Ves No Re-Inspection on or After: ,_^- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS - '- <br /> Cdr <br /> . <br /> Item/Location i Temperature Item/Location I Temperature <br /> Food Safety Certification Facility Hot.Water Temperature Warewashing <br /> Name: Hand Sink: "F Chlorine: PPM Heat F <br /> Exp.Date: arewash g Sink* of ruat.Amm.: Ppm Other: -F <br /> 116� <br /> Received By/Title: <br /> EH Specialist: Phone: -a <br /> ime in: ri l Time Out: -111bPage f <br /> EHD 1624 (2^ pg) 4/y13 J FOOD PROGRAM OR CONTINUATION <br />