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SAN JOAQUIN COUNTY <br /> y� 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 /> �/FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 1110l <br /> Address: z-( City: Zip Code: 95- q <br /> Owner/Operator: v L _ Telephone: { <br /> Program Element: 3f_ Program Record: vrl,3 Inspection Type: <br /> SB180 Posted No Permit Posted No Re-Inspection on or After. <br /> OBSERVATIONS AND CORRECTIVE ACTIONS y <br /> � 0 a <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certi Facility Hot Water Temperature Warewashing <br /> Name: ( Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: / arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> _ wo%- `t%- <br /> ime in: Time Out: Page of <br /> EHD 16-24 (2,ld pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />