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SAN JOAQUIN COUP ' <br /> •.OG <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.. ;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.orq/ehd <br /> �i)i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Yj AV? L ! Date: / J— <br /> Address: City: Zip Code: <br /> Owner/Operator: , Telephone: <br /> Program Element: / Prog am Record: r� Inspection Type ,",,' <br /> B180 Posted ( es ❑ PermitPosted Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item/Location Temperature <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: cF <br /> Exp.Date: Warewashing Sink: of dust.Amm.: ppm Other: of <br /> Received By/Title: , , <br /> EH Specialist: Phone: Q l <br /> Time in: d� Time Out: ^� Pag ofZ <br /> EHD 16-24 (2-pg) 4/f/13 FOOD PROGRAM OR CONTINUATION <br />