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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.orgiehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT ka -
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<br />Address: City: Zip Code:
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<br />SB180 Posted Yes No I Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />, Item/Location lemperature Item / Location, Temperature
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<br />Safety Certification Facility Hot Water Temperature Warewashing
<br />Name. q.., r.. , 1 Hand Sink: oF Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: .F Quat. Amm.:PPm Other: °F
<br />Received By / Title:
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<br />EH Specialist: Ph one:
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<br />Time in: Time Out: Qi ;s-c.1 Pageciof Q
<br />EHD 16-24 (2^d pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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