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SAN JOAQUIN COUNTY <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: u <br /> Address: i S City: Zip Code: (� u, <br /> 1 v✓a <br /> Owner/Operator: Telephone: <br /> Program Element: '4 Program Record: Inspection Type: <br /> B1 <br /> S80 Posted Yes UNo Permit Posted No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a rtlU i�v. "4. `t w&,k �dYt�v� ntn� c v� hn <br /> 1"1 <br /> • - a il) <br /> l ° ._ l d <br /> pqocx �IO L Gt eC <br /> r C• <br /> Item/Location Temperature Item/Location Temperature <br /> rtification Facility Hot Water Temperature Warewashing <br /> -_..._—...---------------- <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: �F <br /> Exp.Date: arewashing Sink: aF Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: b Phone: 9 <br /> Time in: Time Out: Page of <br /> EHD 16-24 (20°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />