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SAN JOAQUIN COUNTY <br /> Z-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... ;P• Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> 4�/PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (f O77 T Date: /11134 1.?-13 <br /> Address: ? n City: Zip Code: <br /> U . U <br /> Owner/Operator: Telephone: <br /> Program Element: /., Program Record: C��^ 7757 2-, Inspection Type: i�_1 <br /> SB180 Posted Yes No Permit Posted Yes No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility F cilia Hot Wate T m rature Warewashing <br /> Name: Hand Sink: LT <br /> of Chlorine: ppm Heat: °F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: �F <br /> Received By/Title: <br /> EH Specialist: Phone: / <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />