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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c•.. P. Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> q�/FORa` <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -t `� i �M Date: <br /> Address: , TU O C� I �J <br /> City: t 1 „a< Zip Code: <br /> (O <br /> Owner/Operator: F4 <br /> re_ Telephone: <br /> Program Element: `f" ProgramRecord: 3 <br /> Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ! Cl Q r m <br /> K <br /> ItemfLocation Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: a� Phone: 45-3 -9819 <br /> Time in: / Time Out: /'7e Page of <br /> EHD 16-24 (2n'pg) 413113 FOOD PROGRAM OR CONTINUATION <br />