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oP�"'"•• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />4crabaaa. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: 2 <br />—1 _ 2 <br />Address: 3SC <br />.-JJ <br />\ City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: , Program Record: j �,u 1(Z <br />Inspection Type: <br />SB780 Posted Yes No Permit <br />Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />— A <br />1 <br />2�2 <br />o.Q <br />- <br />.,LacBtion. <br />Temperature <br />Item l Location <br />Temperature <br />'F'bb Satety'Ce7ti} atlbniiity <br />Hot Water Temperature <br />,: �. Warewashin" <br />ppm Heat: <br />Uai. Amm.: ppm Other: <br />"F <br />°F <br />Name: Hand Sink: "F ��hlorine: <br />Exp. Date: arewashing Sink: 'F <br />Recelved By/Title: <br />EH Specialist: <br />Into In: � ' J� <br />Phone: 6\`in_ 3 2S <br />Time Out: 01" " S <br />Page of <br />FOOD PROGRAM OIR CONTINUATION <br />EHD 1624 IV pg) 413113 <br />