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SAN JOAQUIN COUN'h <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 <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name o1 Facility: <br />Date: <br />—Q <br />Address: <br />City: Zip Code: <br />S n <br />Owner/Operator: <br />Telephone: 0 <br />26/_oS�o <br />Program Element: <br />ProgramWord: 3 12 Inspection Type: <br />r <br />8180 Posted Yes <br />No Permit Posted Yes No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Neme: <br />nd Sink: 'F hlorine: ppm eat: <br />Ja <br />'F <br />Exp. Date: <br />rewashing Sink: -F uat. Amm.: ppm ther: <br />-F <br />Received By/ Title: <br />EH Specialist: <br />J -- Phone: <br />Time in: <br />O �. Time Out: /01 r <br />Page of <br />EHD 1&24 (2n°pg) 41Y13 FOOD PROGRAM OR CONTINUATION <br />