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SAN JOAQUIN COU.- . Y <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: j Date: _ _/ <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element- Program Record: Inspection Type: lz CG'n a <br /> B180 Posted ❑Yes ❑ Rermit Posted F Yes PT Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l © � 10.5e r Ire- Gi n V� r 0'a -e cS <br /> >us <br /> U)92_4_'4 ' ,5Z 6 r 0 <br /> Item/Location Temperature Item t L.ocatio emperature <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: Gt�3___2 :7 <br /> Time in: Time Out: —/ Pag of <br /> EHD 16-24 (2n°pg) 4,13/13 FOOD PROGRAM OIR CONTINUATION <br />