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4"!!Y..C' SAN JOAQUIN COUt <br /> Z-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . .. - ;P• Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.siQov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /�' Date: '/ <br /> Address: / City: Zip Code: <br /> Owner/Operator: �`_ Telephone: <br /> Program Element: Program Record: ,U O Inspection Type: / <br /> SB180 Posted Aes No Permit Posted s ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> .lam <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 1 Hand Sink: of Chlorine: �T/� p Heat: 'F <br /> Exp.Date: Jr�j Warewashing Sinhaof uat. mm ppm they: of <br /> Received By/Title <br /> EH Specialist: P h o e;0� <br /> Time in: ,y Time Out:,.,.-. O Pa g of <br /> EHD 16-24 (2m pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />