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oP41'" SAN JOAQUIN COUN' .Y <br /> ).•.�.COG <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> c..• �P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4�IFOfR t� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: i City: Zip Code: `� �• <br /> Owner/Operator: \C1 �a 61 ,Telephone: <br /> Program Element: !(„� Pro a Record: 1�7 Inspection Type: J n0 <br /> SB180 Posted j Yes ❑ No Permit Posted Yes No �` Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> slotlig. 4� <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Ford fety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: oF Chlorine: Heat: <br /> f.I :[. 1 L 1 d L�-' ppm F <br /> Exp.Date: Warrashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: 77 <br /> EH Specialist: 1� Phone: 4a, <br /> �2 <br /> v� <br /> Time in: r1 Time Out: o Page-,of - <br /> d24 <br /> EHD 16-24 (21'pg) 1/181112 FOOD PROGRAM OR CONTINUATION <br />