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SAN JOAQUIN COUP. <br /> z+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... ;P• Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4�;FOQa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: 'Y7 City: Zip Code: <br /> z6qkuo-7 <br /> Owner/Operator: C LL G Telephone:o� <br /> Program Element: Program Record: ��2 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> .c� <br /> � J Y <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: `F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title <br /> � 77� <br /> EH Specialist: Phone <br /> (qfl� zit <br /> Time in: Time u : r � Page1 of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />