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aQ��N SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •. ;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4CjFp�':d <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: f <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATION§,, N CORRECTIVE<ACTIONS <br /> -------- / Pit -- <br /> --..._ . _........... ---- <br /> item/Location — Temperature Item/Location Temperature <br /> -- --------- --_-- ........ .................. ........ <br /> Food SafetyCertification Facility Hot Wafer Tem rature Warewashing <br /> y <br /> . <br /> Name: Hand Sink: ��0• / °F Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: � 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title <br /> EH Specialist: �S Phone: <br /> Time in: _ Time Out: Q� J Page of <br /> EHD 1624 (2n0 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />