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,n4iN <br /> �o coG SAN JOAQUIN COUNT Y <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ,.•�a• Telephone: (209)468-3420 Fax: (209)464-0138 Web:wwW.sigov.orq/ehd <br /> �4;6W* <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: }� f to Date: <br /> ddress: �, City:fkZ (/, Zip Code: <br /> Owner/Operator: 64 <br /> W\ V ' (-I/t Telephone: <br /> Program Element: J ( / Progr rn -Record: �-(� r�� ,GN � Ins ction Type: <br /> ll li` U i <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> MI <br /> ( J C 1' - <br /> a� <br /> 0,Cfu✓ yk ✓1 > <br /> r it .S <br /> j� — <br /> itern/Location v` Item/Location Temperature <br /> 7 �w ,u hc <br /> d ' uWL I -- -- - <br /> Food Safety Certification Fad*Not Wafer Temp"*w+e Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: - <br /> EH Specialist: Phone: <br /> Time in: Time Out: Pag f <br /> EHD 16-23 (2nd pg) 07129/09 FOOD PROGRAM OIR CONTINUATION <br />