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I_ <br /> SAN JOAQUIN COUN'► . <br /> :t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �.,, ;P.. Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s6gov.or /q ehd <br /> q�/PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /u Date: <br /> Address: City: Zip Code: <br /> id <br /> Owner/Operator: Telephone <br /> Program Element: 5Program Record: Jr/ �,� Inspection Type: <br /> Al 6.3SB180 Posted Yes ❑ o Permit Posted Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS_ <br /> fi✓ <br /> 0 r'1,(1 <br /> Item/Location Temperature Item I Location Temperature Item I 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: Phone: <br /> nee: <br /> in: V Ii` Time Ou . Page of <br /> EHD 16-24 (2n°pg) 4/9/12 J FOOD PROGRAM OIR CONTINUATION <br />