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O�4ulk O SAN JOAQUIN COUNTY <br /> :< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W . <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> gc,�o�a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> L ? L fi i L .i � �• Z <br /> Address: LJ ' City: Zip Code: <br /> s <br /> Owner/Oper for: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B-180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> lvPam - <br /> ItemlLocation Temperature Item!Loaatinit• Temperature <br /> I <br /> - � I <br /> Food Safety Certification L Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: "F Chlorine: ppm Heat: %T <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By I Tltle- <br /> EH 5peclaiisi: f Phone: Z <br /> ime in: Time Out: Page of <br /> EHD 16-24 (2n'pg) 4013 h FOOD PROGRAM OIR CONTINUATION <br />