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A Pa " C <br /> "' SAN JOAQUIN COUNTY <br /> O. . OG <br /> U'i6i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 952056232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.slpov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: ° r'k � City: 1 Zip Code: <br /> Owner/Operator: ,'r t Erk �1 Telephone: <br /> Program Element: ! ! I 1 Program Record: Inspection Type: ? <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r <br /> 1;1\)61:;? <br /> C ' <br /> L Cli av , r A t 1 , <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _... — --._... .--..._— <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm ther: 'F <br /> Received By/Title: ,] At <br /> EH Specialist: r Pho U 14 <br /> i <br /> Time in: oTime Out: ,1 .� T ;,•,� Page f I <br /> a / <br /> EHD 16-24 (2nd pg) 4/3/13 w FOOD PROGRAM OIR CONTINUATION <br />