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SAN JOAQUIN COU` _ <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siov.orq/ehd <br /> �I F <br /> ORD 4 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �. . Date: <br /> - <br /> Address: / City: Zip Code: <br /> Owner/Operator: Telephone: <br /> c� rcF 3 '� <br /> Program Element: Program Record: P — Inspection Type: <br /> B180 Posted YesNo Permit Posted es No Re-Inspection on or After: J� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v <br /> -y <br /> 9 <br /> e <br /> Item/Location Temperature Item/Location Temperature <br /> _...._�. --------- _...__....- L---- --- _..... - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Dat Warewashing Sink: of Quat. Amm.: ppm Other: of <br /> Received By/Title: Ce^ <br /> EH Specialist: Phone:Time in: 20 Time Out: 1^ Page of <br /> EHD 16-24 (211 pg) 4/3113 l FOOD PROGRAM OIR CONTINUATION <br />