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SAN JOAQUIN COUN . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> oq.• a;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �—� -\ Date: <br /> ddress: - <S�_ City: Zip Code: <br /> Owner/Operator: SJ co <br /> O� � Telephone: �b <br /> Program Element: 1 b Program Record: — 2 Q Inspection Type: 9-0v .� <br /> B180 Posted V<Xes ❑ Rermit Posted yes Fl I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 10 <br /> 1 - - <br /> 0 0 <br /> Item/Location j Temperature Item I Location tom= <br /> I{ <br /> Food Safety Certification 1 Facility Hot Water Temperature r Warewashing <br /> Name: _- <br /> IIHand Sink: / of Chlorine: ppm Heat: of <br /> Exp.Date: _jWarewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: y C rIzz n <br /> EH Specialist: W Phone: <br /> Ti—mein: ` r Time Out: Page�of <br /> EHD 16-24 (2-pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />