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SAN JOAQUIN COUN i r <br /> �:•�••.off FV.� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 '�o J <br /> �q.,F -.a;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.segov.org/ehd <br /> ! / 0 <br /> L °R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 36 C <br /> Address: City: Zip Code: <br /> Owner/Operator: / elephone: <br /> Program Element: Program Record: Ins ction Type: <br /> SB180 Posted ❑Yes ij No Permit Posted ❑Yes C No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L <br /> Q <br /> '10- - 00 <br /> r <br /> AP <br /> F QK A <br /> i <br /> ►'L r C , <br /> GV44J ;Vtd�W <br /> h <br /> Item/Location Temperature Item/Lo tion Temperature Item/Location Temperature <br /> - Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: OF <br /> Exp.Date: Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phon : <br /> Time in: r Time Ou : bor Page of <br /> EHD 16-24(2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />