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aP`�`ttft•c SAN JOAQUIN COUNTY <br /> ZA ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r... P Telephone:(209)466-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4C%FOPN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: d 2 lfD <br /> �p <br /> Address: / City: Zip Code: <br /> Owner/Operator: Telephone: �Ilp 741 <br /> Program Element: RIP Program Record: Inspection Type: F <br /> SB180 Posted Yak No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ri O P DSI <br /> X64"7 <br /> ItemLLocation j Temperature d>- heitit/1,.ot "' <br /> Food SafetyCertification Facility Hot Water Temperature : Warewastiing <br /> Name: Hand Sink: 'F Chlorine: PPM Heat: =F_. <br /> Exp.Date: arewashing Sink: 'F Ouat.Amm.: PPM Other: - op <br /> Received By/Title: <br /> EH Specialist: _ Phone: <br /> Time in: 1 Time Out: r / Page of <br /> EHD 1624 (2d Pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />