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SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �IFORe� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: // Code- <br /> , <br /> Date: <br /> Address: , C� li�tlel City, �� �l�, Zip Code: <br /> r <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection;T <br /> SB180 Posted Yes _7 No Permit Posted Yes -i No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> M?_ cc G <br /> s <br /> /' 64o-7 C t <br /> s I �- r q F o <br /> ot1 <br /> Item/Location Temperature Item I Location Temperature Item/Location Temperature <br /> 6,1 AA <br /> f r� �� t �a <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: J� Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: <br /> of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: /n <br /> Time in: tl Time Out: l(��t1 Page of <br /> EHD 16-23 (20°pg) 11/06/08 1 FOOD OR CONTINUATION <br />