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SAN JOAQUIN COUN1 <br /> � •.OG <br /> _ ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> - - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209) 464-0138 Web:vvww.sigov.orq/ehd <br /> 4ikoR�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: r I„„ 0 0 N, City: Zip Code: <br /> Owner/Operator: r/ Y i' 1/ �Z t n n d`C Telephone: <br /> Program Element: /1 Program Record: /�/'��7 /� Inspection Type: - L <br /> B180 Posted d- ❑Yes ❑ Permit Posted V [,Yes ❑ 1 Re-inspection on or After: 1 <br /> . _. <br /> w OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item!Location Temperature <br /> s>. <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppmOther: of <br /> Received By/Title. <br /> EH Specialist: - Phone: - <br /> Time in: f <br /> Time Out: Pagelof <br /> EHD 16-24 (2°pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />