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SAN JOAQUIN COUNTY <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> �: .. X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.so-gov.org/ehd <br /> rg/ehd <br /> 9�/PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility:777 <br /> 77777,:77 Date: I 7 3 <br /> Address: 1 `!:-Ie Q City: —"�� Zip Code: S <br /> Owner/Operator: J Telephone: �J <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 2 , of Chlorine: ppm Heat: nF <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> Received By/Title <br /> EH Specialist: 1_ c Phone: 2-0(::�k ! l r aQ ZS <br /> Time in: O q 1 v\ Time Out: �' �� EMS Pagel of <br /> EHD 16.24 (2n°pg) 4/3/13 l � FOOD PROGRAM OIR CONTINUATION <br /> S <br />