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SAN JOAQUIN COUNTY <br /> a` ya 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 /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ._ Yes;" r,� -�� Date: <br /> Address: a� _ City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: & Program Record: � Inspection Type: _ 3 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> noz ' ,rf✓ 4 mat a_r►�Z eS <br /> �f/� �I <br /> AW <br /> ak <br /> ` t <br /> E�r�"ru 0 •� <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/Titl <br /> EH Specialist: Phone: — <br /> Time in: Time Out: L Page of <br /> EHD 16.24 (2^"pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />