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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.s'gov.org/ehd <br /> 4��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \C ti Date: <br /> Address: -7- l A 1 \ City:— r Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: �o2pt(3 Inspection Type: S \ <br /> SB180 Posted Yes No Permit Posted Yes No ` Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> \_ <br /> 1 b`b <br /> 12 V <br /> IIL <br /> Item/Location Temperature Item J Location Temperature <br /> i <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: b fO <br /> Time in: 12 Time Out: lJ Page of <br /> EHD 16-24 (2-Pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />