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pP4N!.N, F SAN JOAQUIN COUNTY <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> a 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a4rlFsn�P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l Date: <br /> ddress: I t City: Zip Code: <br /> N. <br /> Owner/Operator. l O Telephone: <br /> Program Element: Program Rec Z Inspection Type: <br /> SB180 Posted Yes o Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS! <br /> r <br /> eW <br /> C <br /> � 1" IA 1 A4 <br /> - <br /> Gds <br /> (, 74 t <br /> Item/LocationTemperefure Item Itocation - Temperature <br /> FoodtSafety,Certification Facility Hot Water Temperature- Warewashfng, _ <br /> Name: Hand Sink: of Chlorine: ppm Heat: "F <br /> Exp.Date: arewash' nk: "F Quat.Amm.: ppm Other: 'F <br /> Received By I Title: 77 <br /> , <br /> EH Specialist: Phone:Z(� <br /> a UV <br /> Time in: Time Out: Page of <br /> EHD16-24 (2^ pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />