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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazefton Avenue, Stockton, CA 95205-6232 <br /> . c�.,• n ;w Telephone:(209) 468-3420 Fax:(209) 464-013$ Web:www.sigov.orc}/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: C C] City: — Zip Code: <br /> Owner/Operator: J 1� Telephone: <br /> Program Element: Q Program Record: 7S 3'-A'O Inspection Type: <br /> B184 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVATIONS AND CORRECTIVE ACTIONS <br /> 2 rt S - <br /> f r0 <br /> fi�J 2 -r <br /> S` <br /> ItemlLocation Temperature Item 1 t.00atton Temperature <br /> �s-3 �3 szr <br /> Safety Certiflcatio Facility Hot Water Temperature warewashing <br /> Name: 'Hand Sink: F Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm then: `F <br /> Received By!Title- <br /> EH 5pecialis • 1_ Phone: 2C)Gk! <br /> Ime in: \ Time Out: V Pal of <br /> EHD*24 (2i1 pg) 41303 FOOD PROGRAM OIR CONTINUATION <br />