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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _= 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• .,.�;;p Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: - City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: // G/S Program Record: /J� 4?, � — Inspection Type: ' <br /> B180 Posted Yes! No Permit Posted Yes/ No J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> nPrIA, IDS <br /> 40- F <br /> r <br /> e Cf pla�rk-- ^ f <br /> i• e r <br /> ` r � <br /> 7 i � � <br /> F <br /> Li <br /> c1-4 atA <br /> s y1lar 1_" <br /> C L <br /> Item/Location T perature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Ali I iiiiiiiiiiiL! Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: ?� `7 <br /> Time in: Time Out: •tom 1 J G Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR mfrINUATION <br />