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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.., ._,.�;;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: LF? <br /> 2- <br /> ddress: C ty: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: A) � Program Record: _ 0 n .2 l Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> V'N elIa 1,4 r, ro ze—. 141 <br /> ,0 o0pion In <br /> 3 <br /> x a <br /> t <br /> ­6 0S q�s <br /> ' IMr, u <br /> , e <br /> l�v ZZ <br /> ltem/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature _ Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: i <br /> EH Specialist: Phone: <br /> 3�S 2 <br /> Time in: Time Out: Page of <br /> EHD 16.24(2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />