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,0t4 .co� SAN JOAQUIN COUI ' <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q..• ¢ .a;P• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s4gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: j� City: _ e 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 ACTIONS <br /> 141 <br /> T • <br /> lei c� <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> --- ---— ---- --- -----— — —— .......... __.... <br /> ---- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/ -itle <br /> EH Spec' s . Pho d�;7 <br /> Time in: '/. Tim Out:a 5b Pag of <br /> EHD 16-24 (2"'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />