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�o� coa SAN JOAQUIN COU <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q._ ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 o (' ( K 5 k6d< <br /> Date: , S 1-3 <br /> Address: Z City: /rr Zip Code: 530 y <br /> Owner/Operator: Telephone: y S <br /> Program Element: Program Record: Inspection Type: r7 G V fin <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: I� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item!Location Temperature Item/Location Temperature <br /> r 1 <br /> ...._-- -- , _ <br /> Food Safety Certification Facility Hot Water Temperature- Warewashing <br /> Name: Hand Sink: / of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: IT of Ouat.Amm.: ppm Other: of <br /> Received By/Title: J71 <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page_of _ <br /> EHD 16-24 (2'1d pg) 4/9/12 FOOD PROGRAM OR CONTINUATION <br />