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SAN JOAQUIN COUNTY <br /> i.•.�.CGG <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.orq/ehd <br /> 4�lFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: — <br /> Address: 2-2k i-\ City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type:�� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: IC <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cc) C.`, ; v <br /> t <br /> t v � <br /> -74U 1c�t2bb 2cA ':r- <br /> c-) S ©b <br /> .� 0-1 <br /> - <br /> ' s <br /> Q� S —rl—I CIS <br /> 'f\r ;n _ <br /> o, <br /> 4 ` 2 <br /> Item/Location Temperature Item/Location Temperature <br /> 2 �C� ` 2 of <br /> C ( ' - <br /> S,. ' k <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppmHeat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM]Other: of <br /> Received By/Title: V i <br /> EH Specialist: Phone: 3 � <br /> Time in: Time Out: t ' �� Page,of <br /> EHD 16-24 (2nd pg) 4/3/13 5�i FOOD PROGRAM OIR CONTINUATION <br />