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ocA++'N•.F SAN JOAQUIN COUNTY <br />?a ENVIRONMENTAL HEALTH DEPARTMENT <br />N: < <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• ;w Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sogov.org/ehd <br />'rCl vd'A`' <br />Fnnn PRnr;RAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Address: <br />SF— <br />City: <br />Date: —1-2--2--2— <br />1--2—ZZAddress:� <br />(. Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />9 <br />S y 3 3 `7 <br />Inspection Type: <br />SB180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS '' <br />r <br />M <br />--Item/Locetl - emperature <br />Item / Locations <br />- <br />Temperature <br />bod a ety:Cefti (cation V.Facility Hot Water Temperature <br />_ Warewashiti <br />Chlorine: ppm Heat: ^p <br />Qua. Amm.: ppm Other: =p <br />Hand Sink: <br />Name: <br />••F <br />arewashing Sink: 1 1 ^ <br />Exp. Date: <br />"F <br />ed By / Title: <br />cialist- <br />Elmsf1r r'Z <br />�J <br />Phone:b--3c)Z 5: <br />FOOD PROGRAM OIR CONTINUATION <br />EHO 16-24 (2rd pg) 41313 S <br />