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�aPAH!N''.coc SAN JOAQUIN COUNTY <br />" ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cdC)koa ;i Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />ame of Facility: <br />Date: <br />ddress: .2 <br />C ^ <br />City: --- G ` <br />Zip Code: <br />ner/Operator: <br />Telephone: <br />Program Element: ` ` <br />Program Record: S�_-t <br />9S <br />Inspection Type: <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />S <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />W. 2A <br />k <br />e e <br />A <br />C <br />6<�) <br />\ <br />" <br />- Item/Location'F- <br />- <br />Temperature <br />Item /Location <br />- • <br />`Temperature <br />`{ <br />a« _- <br />y <br />,,NAa <br />R <br />F,00d.Safety Certification <br />Facility Hot Water Temperature <br />Warewashing.. <br />Name: <br />Hand Sink: <br />of <br />Chlorine: <br />ppm Heat: <br />'F <br />Exp. Date: <br />arewashing Sink: <br />of <br />Quat. Amm.: <br />ppm Other: <br />'F <br />Received By / Title: <br />j <br />EH Specialis• <br />Phone: <br />Time in: + \ <br />Time Out: \ <br />+ l <br />Pag f .2 <br />EHD 16-24 (2^ pg) 4IN13 FOOD PROGRAM OIR CONTINUATION <br />A <br />