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SAN JOAQUIN COUNT � <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _= 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 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: U r a 4 P'r j n Date: 2 O - <br /> 2- <br /> ddress: $ S' S G rt( r City: It <br /> r Zip Code: '?,5 3 j�C <br /> Owner/Operator: Telephone: 8-3 q _Itr <br /> Program Element: Program Record: Inspection Type: , <br /> CU �� .1f <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U i a r1 3 <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title- <br /> EH Specialist: Phone: (j <br /> Time in: 'G`; Time Out: Page o`2 <br /> EHD 16-24 (2M pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />