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Pa"I" SAN JOAQUIN COUP <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: c :< <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/eh <br /> �%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Cal � J i7 Date: <br /> Address: ?5 3 Qs G� City: < Zip Code: �Jr <br /> Owner/Operator: v Telephone: as <br /> Program Element: Program Record: 620 D 09 D Inspection Type• U �� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r"w" <br /> v n d,•fi e rn.e f <br /> m lb 3 Fee—Alo <br /> Item/Location Temperature Item!Location Temperature <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat Amm.: ppm �other: 'F <br /> Received By/Title: - 1 <br /> EH Specialist: Phone: <br /> v <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2^"pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />