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SAN JOAQUIN COUNTY <br /> Q' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. _ ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sbgov.org/ehd <br /> 9��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J ^� �• �� l� LG/ Date:,, <br /> Address: 12, <br /> c�.( �� Fit— �b�A City: � Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: ` �� Program Record: I <br /> P r Inspection Type: a <br /> 3 �io 94 :n <br /> SB180 Posted Yes o Permit Posted Yes (09 <br /> o Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> /A I ra GE <br /> �(L.M I � S � I • <br /> Item/Location Temperature Item f Locati em'perature <br /> Food Safety Certification Facility Hot Water Temperature _Warewashing° <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: 'F <br /> Received By/Title: - <br /> EH Specialist: Phone: <br /> Time in: Time Out: Pag of <br /> EHD 16-24 (2ndpg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br /> j <br />