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4"'" SAN JOAQUIN COUN <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: x <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . ... `P.. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.slaov.org/ehd <br /> 4Li FOR�a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \ Date: <br /> Address: xq <br /> City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Rec rd: O 3 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> q hs- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 4-f' Z- <br /> CAA <br /> olk <br /> 'YVIi <br /> f q1 <br /> " L <br /> r-- i <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certifications Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: aF Quat.Amm.: ppm other: of <br /> Received By/Title:V• <br /> zft <br /> EH Specialist: Phone: <br /> Time in: AAJ ime Out: Page <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />