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pa�lk' SAN JOAOUIN Cour <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �rpoR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ^ Dat! <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> �., OBSERVATIONS AND CORRECTIVE ACTIOhjS <br /> -_---- ------ ----.. ... <br /> Item/Location Temperature Item/Location — Temperature <br /> Food Safety Certification Facility Not Water Temperature Warewashing „ <br /> Name: 'Hand Sink: °F Chlorine ppm 'Heat: °F <br /> Exp.Date: �arewashing Sink: -F Quat.Amm.: ppm (Other: -F <br /> Received it <br /> EH Speci list: Phone: <br /> Time in: Time Out: Pagd:2of <br /> EHD 16-24 (2^dpg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />