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oP" " ' " o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , CA 95205 - 6232 <br /> Telephone : (209 ) 468 - 3420 Fax: ( 209 ) 464 - 0138 Web: www . sigov . org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility : Date . 1. . <br /> Address : City: Zip Code : <br /> Owner/Operator : V Telephone . <br /> Program Element : Program Record : `..� 21.1 Inspection Type : <br /> SB180 Posted Yes No Permit Posted Yes No Re- Inspection on or After : <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � A <br /> f <br /> oolib <br /> ` Z 140F 0;4A <br /> � + r <br /> 7 <br /> Aorte, A,4 <br /> b2r t <br /> alot <br /> , <br /> Item/Location Temperature Item / Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name : Hand Sink: OF Chlorine . ppm Heat . o IF <br /> Exp . Date : Warewashing Sink . OF Quat. Amm . . ppm Other . OF <br /> Received By / Title . <br /> EH Specialist : Phone : <br /> ime in : Time Out Page of <br /> EHD 1 &24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />