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q"" SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />�/FOka <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: \ ��CA <br />S ` Date: S.- , -Z <br />Address: ` 1 -} <br />I <br />Q # City: Zip Code: 9 S ,Z <br />Owner/Operator: <br />c Telephone: C4 <br />Program Element:` <br />�Z <br />Program Record: S 2 ©Ob Z Inspection Type:; <br />SB180 Posted - Yes <br />_ No <br />Permit Posted Yes a No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />- <br />Q.. <br />�'Z c <br />S' Ac \l <br />s. L <br />1-1 F F- <br />C <br />\ \ <br />`ti \ <br />P <br />t` z t C 41D <br />Item/Location <br />Temperature <br />Item / Location Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: of <br />Chlorine: ppm <br />Heat: of <br />Exp. Date: <br />Warewashing Sink: of <br />Quat. Amm.: ppm <br />Other: of <br />Received By/ Title: <br />EH Specialist: <br />Phone: <br />Time in:�� <br />Time Out: Z'� Page `of l <br />EHD 16.24 (2^d pg) 1/18/12 1 FOOD PROGRAM OIR CONTINUATION <br />