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oAq�l" SAN .1OAQUIN COUNTY <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _= 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•. ,.�;;P Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.siclov.org/ehd <br /> 5 iF <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , S. Date: <br /> Address: F City: Zip Code: <br /> td <br /> Owner/Ope or: L / ,p Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> zC <br /> K8-0posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> s OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S <br /> dCA <br /> No <br /> &?w ilk S , <br /> �yt12 <br /> v� <br /> 4 <br /> o AA2 uJ <br /> 47 <br /> r <br /> v <br /> oa. <br /> H... , <br /> Item/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: <br /> EH Specialist: Phone: / OCR <br /> Time in: c1q,r 'p Time Out: 2 c� PaPAIge of <br /> a <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />