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oA4k'� • SAN JOAQUIN COON* <br /> a••Qsa•F�� . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: -� City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: ` Program Record: O ZS Inspection Type: KIP-- <br /> B18U Posted Yes ❑ No Permit Posted Yes ❑No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �cJ /� wce� ami c%-sS <br /> a. `C/ 1.2' 7�MO 747 l aA) <br /> a = IVAI 7,C-'-k -4 awl <br /> z5Kx Ll&I/ -0/.38 <br /> 011 r = � W-O-s s <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Al <br /> F od Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: /� eFChlorine: PPM eat: eF <br /> Exp.Date: arewashing Sink: /3� eF uat.Amm.: PPM then: eF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> 'O <br /> EHD*24 (21d pg) 11f1lQ9 FOOD PROGRAM OIR CONTINUATION <br />