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SAN JOAQUIN COUNTY <br /> X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . oq.. a;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: p ^— Z <br /> ddress: F <br /> City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: r 6 q ` Program Record: O S-0 ?Z �S Inspection Type: <br /> 8180 Posted Yes / No[ J Permit Posted Yes No J v J Re-Inspection on or After: <br /> OBSERVATIONS AND CORREQTiVE AC ONS <br /> �- cz(lely — <br /> r <br /> ` � c <br /> az <br /> t G Y lM <br /> i►1 Z _ . ,l� <br /> S ✓ r ►-v� I o <br /> pry <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: �F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 7nj —�� Phone: Da !Z_ (% � —� <br /> Time in: Time Out: , [� Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />