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SAN JOAQUIN COUN i Y <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.s'gov.org/ehd <br /> 96iF6'aia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: (/ <br /> Address: Sr City: Zip Code: q5Z�y_ <br /> W <br /> Owner/Operator: Telephone: <br /> p, <br /> Program Element: Program Record: Pp_oN 11:�'i bq Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No) IY Re-Inspection on or After: <br /> C OBSERVATIONS AND CORRECTIVE ACTIONS <br /> • t} <br /> G O✓L <br /> F <br /> � 0 <br /> vad, <br /> �-� fewyAJIV vv `rr�-., t1 a-co <br /> y <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: a Phone: >�]� _ t,�/0 /f <br /> Time in: Time Out: l( CJ V Page of <br /> EHD 16-24 (2otl pg) 4/3/13 FOOD PROGRAM OR CON IINUATION <br />