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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.slgov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: <br />Address: 1 ` City: Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: rog m Record. --Inspection Type: ; S; <br />SB180 Posted Yes No Permit Posted Yes No Re -Inspection on or After: <br />EHD 16-24 (2nd p9) 4/3/13 ruuu rnuunrsn uin uuiv i uvun lulu <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />A70 <br />AC— <br />.Z - - <br />-Z <br />-Z <br />- <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />...... <br />Food Safety Certification <br />Facility <br />Hot Water <br />Temperature <br />-- <br />Warewashing <br />Name: <br />Hand Sink: <br />aF <br />Chlorine: ppm <br />Quat. Amm.: ppm <br />Heat: 'F <br />Exp. Date: <br />Warewashing Sink: <br />Other: of <br />Received By/ Title: <br />1 <br />EH Specialist- <br />Phone: <br />Time in: <br />Time Out: Page of <br />EHD 16-24 (2nd p9) 4/3/13 ruuu rnuunrsn uin uuiv i uvun lulu <br />