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SAN JOAQUIN COU.
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />600 East Main Street, Stockton, CA 95202-3029
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orcilehd
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<br />F000 PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: (.714 .42...K12,3, po-s4) Date: 9(
<br />Address: City: AftrE
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<br />Zip Code: Cfr xt
<br />Owner/Operator: oil 4...6_
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<br />Program Element: Program Record: Inspection Type:-
<br />SB180 Posted L Yes II No Permit Posted 1 Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS -
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<br />Item/Location Temperature Item / Location Temperature Item! Location Temperature
<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: o F Chlorine: ppm Heat: °F
<br />Exp. Date:
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<br />Warewashing Sink: o F
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<br />Quat. Amm.: ppm Other: °F
<br />Received By / Title: '
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<br />EH Specialist: trvabuy,i, phon 7 ..„ LEG A9 es.?Lt o Time in: ita ste- Time / :as Pagel of 1
<br />EHD 16-24 (2'p g) 11/2/09 FOOD PROGRAM OIR CONTINUATION
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