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SAN JOAQUIN COUNTY <br /> ).•tea'A <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> .. e. ; Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 9�%FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: 33 <br /> City: Zip Code: <br /> Owner/Operator: ephone• <br /> v <br /> Program Element: Program Record: kinspeeflon Type:, C <br /> SB180 Posted Yes No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> ATIONS AND CORRECTIVE ACTIONS <br /> 66 <br /> A t <br /> .4 Adr— <br /> r8 DAV <br /> co MM44A A& <br /> D <br /> w � <br /> IV <br /> (7 <br /> E <br /> itefnlLoCattOr! J;0�re Item/Location_ Temperature Item/Location Temperature <br /> Food Safety Certification Facititrl Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: -F Quat.Amm.: ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: hone• <br /> Time in: Awo - - Time ut: -0 Page/Of ' <br /> EHD 16-23(2nd pg) 07/29109 v" FOOD PROGRAM OR CONTINUATION <br />