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<br />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.siqov.org/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
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<br />Zip Code: at s L...1
<br />City:
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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 1Narewashing
<br />Name: Hand Sink: F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: o F Quat. Amm.: ppm Other: °F
<br />Received By / Title:
<br />EH Specialit;______r_e_ N.-.14„Novs...9,2_ Phone: 2 0, _ ice to_ so25
<br />Time in: k , s ---, Time Out: t 2, .. zs e Page of
<br />EHD 16-24 (2^d pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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