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�gP4.e�.e SAN JOAQUIN COUNTY <br />?s ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.oro/ehd <br />uFaa� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: D — <br />Address:.7 <br />Zlp Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: Revp <br />SB180 Posted Yes No <br />Permit Posted Yes No Re -Inspection on or After: <br />oeyo y4 e 4 g 7-.1 <br />OBSERVATIONS AND CORRECTIVE ACTION <br />e�A.( S jb g56(rr1= / E,o 7-0,15, A <br />P d <br />i4 H tlRic o Ol./AW7o <br />or epp-r <br />/ ci Nct <br />Item/L- _`tore Item l Location <br />Food Safety Certification Facility Hot Water. Temperature <br />Name: Hand Sink: 107 `F hlorine: ppm Heat: <br />I Temperiiture <br />�- <br />'F <br />Exp. Date: <br />arewashing Sink: 'F <br />Quat. Amm.: <br />ppm Other: <br />'F <br />Received By/ Title: <br />EH Specialist: AL, <br />l•%1 <br />Phone: <br />�! ., 8 /'j <br />Time in: 3 O <br />O —A Time Out: I O <br />30 q <br />Pag�,of. <br />EHD 16-24 (2n° pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />