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opQ1N SAN JOAQUIN COUNTY <br /> 2 ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: a <br /> -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www,sigov.or, IA ehd <br /> Cii=oR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: 1� S+ City: moi_. zip Code: , <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑i Re-Inspection on or After: <br /> OBSERVATIONS ANI .,CORRECTIVE ACTIONS <br /> J ♦ ( 1 ` <br /> Itemlt.ocatlon Temperature Item I t-ociztion Temperature <br /> Food Safety Certification Facility Hot Water Tempsraturs Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By!Title: <br /> EH Specialist: Phone: <br /> 4b--0 <br /> Time in: Time out: 1 Page Cf <br /> 0,C <br /> EHD 16-24 (2^1 pg) 413113 FOOD PROGRAM OR CONTINUATION <br />