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SAN JOAQUIN COUNO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �q..• ?•.�;;p Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 71--o 3 <br /> Address: City: Zip Code: r�� <br /> Owner/Operator: ephone: <br /> Program Element: P ogram Record: Inspettion Type: . <br /> S6180 Posted - Yes - Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 94c Q <br /> AL a <br /> d J ,7LU <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> F _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: t:' of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 4 6 —(~7�� <br /> ime in: /`�("' Time Ou: roS (� Page of <br /> EHD 16-24 (2nd pg) 1/16/12 v� FOOD PROGRAM OIR CONTINUATION <br />