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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.- .��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: f Q" A i 7"kDate: ` <br /> Address: City. �� Zip Code: <br /> Owner/Operator: Telephone: <br /> tri <br /> Program Element: Pro ram Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l I : Z 1-1 ;L CK N � c <br /> Q . <br /> u <br /> • <br /> pl � � <br /> az+ 2 <br /> Item/Location Temperature Rem/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: U �' <br /> EH Specialist: Phone: I^ (fir ?v <br /> Time in: Time Out: 1 `� Page of <br /> 1 w <br /> EHD 16-24 (2,d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />