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SAN JOAQUIN COUNTY <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • 04., �.,..�i• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> t1Foa`" <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: city: Zip Code: <br /> Owner/Operator: A.- . none:✓ <br /> Program Element: Program'Record: J(/K' I spec Type:_C <br /> SB1 SO Posted es ❑ No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rl t/t C a <br /> 2 J <br /> ' <br /> Itern/Locatiolil Temperature Item I Locatio . Temperature <br /> i / 'F Ter 5a 'F 0 ,F <br /> b- C T rug' C�lP2 0'� <br /> �7ood Safety cern icahon-,.-e Facility Hot Water Temperature - ="W rewashing - - - <br /> Name: Hand Sink: 'F t'Chlorine: PPM Heat: aF <br /> Exp.Date: �a arewashing Sink: 'F Quat.Amm.: PPM Other: 'F <br /> Received By/Title: /h <br /> EH Specialist: Phone• �3 <br /> Time In: r Time Out: �1� Pag of <br /> EHD 16-24(2"pg) 11/7109 O FOOD PROGRAM OR CONTINUATION <br />