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SAN JOAQUIN COU,. _ Y <br /> P • <br /> �O. .COG <br /> q ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: o— Date: •i <br /> Address: City: Zip Code: <br /> Owner/Operator: �� Telephone: <br /> Program Element: BZ Program Record: /,Z In$p �tio Type•• <br /> K C� W <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U ✓ �c� <br /> CAS ,C.f h ,�ldf �u. X16 <br /> S7 Al <br /> � 3 <br /> Il (J*� vwt Q7 t c� tv GIl v� eH l� <br /> he IdtfiUd. <br /> tem/Location AW Temperature Item/Location Temperature Item/Location R Temperature <br /> ood Safety Certification Facility Hot Water Temperature -.Warewashing <br /> Name: l I - Hand Sink: ��r'!_ of Chlorine: ppm Heat: OF <br /> Exp.Date: a Warewashing Sink: f of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: h ne: ' J,� �� <br /> ,1 <br /> Time in: ' r J' Time Out: l•C Page of <br /> . V <br /> EHD 16-24 (2-pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />