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oPaul"• SAN JOAQUIN COUNTY <br /> a` ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a• ;e Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.ora/ehd <br /> °uFa'a+ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \je Is Date: <br /> Address: city: Zip Code: <br /> OwnerlOperator: Telephone: <br /> Program Element: 1., S Program Record: 5 �O1 G� Inspection Type: <br /> smo Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 5 - i= UNY-N l-1 l-7 �✓l <br /> L <br /> _ 1teMLocatl4 Temperature - Item/Location Temperature <br /> " od Safety certifica Facility Hot Water Temperature Warewashing <br /> _ — __— __ <br /> Name: and Sink: 12� `F Chlorine: Ppm Heat: "F <br /> 4x 5 - <br /> Exp.Date: �2 - Z arewashing Sink: I?� =F Ouat. Amm.: PPm Other: *F <br /> Received By/Title: J <br /> EH Specialist: - Pho e: ` 1_ r <br /> Time In: , Time Out: 1 Page' of <br /> EHD 1&24 (2n Pg) 411 FOOD PROGRAM OIR CONTINUATION <br />