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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: wwvv.sjcpv.orgiehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
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<br />Program ElemenLx).1 i k -, s Program Record: ‘ vocFit ..4 v..)/ 5 ts- 039 Inspection Type:
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<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS , . ,
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<br />Item/Location Temperature Item / Location Temperature
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<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: ,F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: ,,F Quat. Amm.: ppm Other: °F
<br />Received By! Title:
<br />EH Specialist:Phone: ,_,----r,-,-L',_ -• c.-.1 _ c..:.) \ 6 c, . 3 L....„..., .-..(-_
<br />Page—of Time in: -- '. S 3 ci
<br />Time Out: (71 ; ‘ , r,-
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<br />EHD 16-24 (2nd pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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