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aQu�" SAN JOAQUIN COUI t <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0: I X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orq/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 02� <br /> Address: //�`{�� City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: 0 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �x <br /> --&/A <br /> -= ----------------------------- -- <br /> - _- ------ -- ---_ _ -- - <br /> Item/Location 1 Temperature Item/Location f Temperature <br /> V <br /> Jay Oki L7J, <br /> /� cation Facility Hot Water Temperature I Warewashmg <br /> ood Safe Certification <br /> Name: uje1, 1 Hand Sink: 1� F Chlorine: ppm Heat. F <br /> Exp.Date: Y iarewashing Sink: of Quat. mm.: ppm Other. of <br /> Received By/Title: <br /> EH Specialist: Phone: Wei <br /> ime in: _V Time Out: Page 2of-�7 <br /> c !� <br /> EHD 16-24 (2nd pg) 4/3+13 FOOD PROGRAM OR CONTINUATION <br />