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SAN .JOAQUIN COUN <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Facility Hot Water Temperature <br />Hand Sink: <br />��� '7 <br />Date: <br />Address: `) � � <br />l„ ' , a-/� . <br />NSC <br />r City: <br />Zip Code: <br />Owner/Operator:, <br />pK!/v'K „ D <br />T( <br />Telephone: ,�]),q3 ' <br />J <br />Program Element: <br />/ �'/� Program Record: <br />tY <br />D s� fdl// <br />Inspection Type: <br />6180 Posted <br />❑ Yes ❑ Permit Posted <br />❑ Yes ❑ 1 <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />' <br />Name: <br />Facility Hot Water Temperature <br />Hand Sink: <br />of Chlorine: <br />Warewashing�-- <br />ppm 'Heat: <br />of <br />Exp. Date: <br />arewashing Sink: <br />of <br />Quat. Amm.: <br />ppm <br />Other: <br />of <br />Received By ! Title: <br />EH Specialist: <br />Phone: <br />qj / <br />Time in: , <br />Time Out: <br />Page] of )l <br />EHD 16-24 (2nd pg) 4/3/13 <br />FOOD PROGRAM OIR CONTINUATION <br />