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044�1� SAN ,JOAQUIN COUNTY <br />Q• <br />z ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /><<FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 1 - Date: / ® ..tr_ <br />ddress:t City: Zip Code: T' <br />Owner/Operator: SAL — elephone: <br />Program Element: Program Record: Inspection Type: <br />SB180 Posted . Yes ❑ No Permit Posted Eirfes ❑ No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Locatia " ' <br />" Item 1 Location Temperature <br />Food Safety Ce ification <br />Name: <br />Exp. Date: <br />Facility Hot Water Temperature, <br />Hand Sink: �R` .FChlorine: <br />arewashing Sink: 1 .F Quat. Amm.: <br />Warewashing <br />ppm Heat: �F <br />ppm Other: OF <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />D <br />Y_� J <br />Time in: V <br />Time Out: <br />. u Page of <br />EHD 16.24 (21d pg) 11/2/09 FUUU VKUUKAM UIK UUN I INUAI IUN <br />