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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 - - Date: 1 _ A_ 1 G <br /> Address: 2 S City: 6111 C Zip Code: 5 3 A —7 <br /> Owner/Operator: Telephone: <br /> Program Element: W2 ` Program Record: �� Inspection Type: `�_O <br /> 1§7B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: �� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Jt <br /> \ � <br /> '2 <br /> 3 -e v ( e- <br /> 'k e- C <br /> s s C <br /> Item/Location — Temperature Item/Location T Temperaturev <br /> — — - ...._-... ........ <br /> -_- <br /> 11 <br /> Food Safety Certification Facility Hot Water Temperature j Warewashing <br /> Name: (Hand Sink: 'F Chlorine: ppm Heat:F <br /> Exp. Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> <_ <br /> Time in: 1 " \,A O Time Out: Pagel of <br /> EHD 16-24 (2W pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br /> 5 <br />