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SAN JOAQUIN COUNTY <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.• a�P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL, INSPECTION REPORT <br /> Name of Facility: -I� I Date: <br /> Address: q 1 City: 1 T� f`� Zip Code: 15za <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: s-v t Inspection Type: <br /> SB180 Posted Yes NO) Permit Posted es No 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> • J +S 110 A <br /> 5� t� <br /> oyti;r LOVI <br /> q <br /> o CaYY> <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: oF,• <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> _ _ rte— <br /> Time in: Time Out: Page of <br /> EHD 16-24 (21"pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />