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aga4tn..o SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•.e•.., y'r • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.oro/ehd <br />4CIFORa <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />ddress: <br />J <br />tj Zip Code: <br />Owner/Operator: <br />._ <br />Telephone: <br />Program Element: Prograni <br />Record: 3 <br />Inspection Type: <br />B180 Posteda No Permit <br />Posted a No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECT VE ACTION. <br />' <br />1tem/Location ' <br />Food Safety Certification <br />Name: <br />Exp. Date: <br />'7ehiperature <br />Facility Hot Water Temperature <br />Hand Sink: 'F Chlorine: <br />Warewashing Sink: `F uat. Amm.: <br />rewa <br />PPM Heat: of <br />Ppm Other: `F <br />Received By / Title: ) <br />EH Specialist: <br />f6A! <br />Ai a ./_ Phone: <br />[�1�- <br />ime in: <br />Time Out: <br />Pag of <br />EHD 1644 (2d pg) 4/3J13 FOOD PROGRAM OIR CONTINUATION <br />