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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ) Date: 1 <br /> Address: a I lV I C J Sc c, + } City: 1 C• Zip Code: C�L(4 <br /> Owner/Operator: Telephone: 3 16 .St O <br /> Program Element: Program Record: Inspection Type: ,pp <br /> �nUa ��II � <br /> SB180 Posted L Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I �U,I, r\ I,e 61. <br /> S vt C rr pC <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: � <br /> nd Sink: lG ; of Chlorine: ppm Heat: of <br /> / Y:^ �'),r . _ <br /> - - <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: °F <br /> Received By/Titl r' <br /> EH Specialist: Phone: <br /> Time in: Time Out: �. J Page of <br /> EHD 16-24 (2ndpg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />