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"411" SAN JOAQUIN COUt <br /> „. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd ( L <br /> �lFpRa / <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ' r <br /> Address: 22.12 ,? city: fo\c Zip Code: c,t 3--77 <br /> Owner/Operator: Telephone: _ofOct <br /> Program Element: \bZy Program Record: 52 -1 1` Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: ? <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> b ew. l � - <br /> t �•re e 2 he 1 -F <br /> nntQ y <br /> ' 1 b <br /> a <br /> c\ <br /> SQ \ r L <br /> �2 !Q� � e � bU � 1��-• <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> - -- -- - ..._.......-.......... <br /> - — <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: - - a Phone: �'-kb ^02 <br /> Time in: �� 2_� Time Out: 2_ \ J Pag of 3 <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />