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SAN JOAQUIN COUNTY <br /> Q` y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... J �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.orq/ehd <br /> 4CjFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: 7 City:..iz <br /> r TIN hd' Zip Code: �' r <br /> t k' .i' l ,, <br /> Owner/Operator: j Telephone: _ <br /> qsq <br /> Program Element: Program Record: Inspection Type: n <br /> 8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: - <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> fe, y A <br /> _ ' �}cam �,� l �� � I ._ 1 �""�' <br /> _ / r` <br /> Item/Location Temperature Item l Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink of Chlorine: ppm Heat: of <br /> Exp.Date. arewashing Sink: aF Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ti) Phone: �1 - <br /> \ <br /> ime in: , r�'y Time Out: ` :�� Page of <br /> EHD 16-24 (2nd pg) 4/3/13 I '' FOOD PROGRAM OIR CONTINUATION <br /> r <br />