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oP41'"' SAN JOAQUIN COUN• <br /> x•' '•.oG <br /> .4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c4.. �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A Date: 'Z <br /> Address: City: Zip Code- Zig S` <br /> Owner/Operator: Telephone:ZO O <br /> &t <br /> Program Element: U Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS x ` <br /> y <br /> e ..c. <br /> cc <br /> d .( <br /> f ° � <br /> &-)ez., �4 <br /> e i <br /> Item/Location Temperature Item/Location Temperature <br /> r <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: q,, <br /> 3� Page of <br /> EHD 16-24 (2°"pg) 4/3/13 1 FOOD PROGRAM OR CONTINUATION <br />