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,Q�,I". SAN JOAQUIN COL -Y <br /> 4 � ENVIRONMENTAL HEALTH DEPARTMENT <br /> -- _ Y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �%FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: Z ! <br /> Address: City: Zip Code: <br /> Owner/Operator: Jkk1n Telephone: '�.. Gt <br /> Program Element: 1(, <br /> V ) ,1 Program Rec d: d--71 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No 1 Re-Inspection on or After: <br /> - OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ` --- <br /> - n <br /> 44 ro <br /> AV-S14 lAdd&�aa <br /> ,�J�{ivvw <br /> - - <br /> Iteni/Ltion �_Temperature I_ ' Item J Location } mperature <br /> ocaL� C�_ <br /> h �2 <br /> Facility Hot Water T'em erature Warewashing � <br /> Name: Hand Sink: i v of Chlorine: PPM Heat: `F <br /> Exp.Date: Warewashing Sink: L Z of Quat.Amm.: PPM Other: of <br /> Received By J Title:' <br /> EH Specialist: Phone: <br /> Time in: a r SD Time Out: Pag of <br /> EHD 16-24 (2^ pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />