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SAN JOAQUIN COUN <br /> ZX ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s4.ov.org/ehd <br /> �rFoa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \ I Date: <br /> Address: City: Zip Code: 0( S Z� <br /> Owner/Operator: 1 \k Telephone: <br /> Program Element:,4b 1 Program Record: O1 Inspection Type: 1 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND Ct3RRECTIVE ACTIONS, <br /> �� ��'r"--L 4- r-2(2s r ---._._.._....__............ __ <br /> Item/Location �, Temperature I T- Item 1 Location I Temperature <br /> -- —- —��� .....- ----- <br /> VJ <br /> ood' afet , ` <br /> y Certification 11 Facility Hat Water Temperature Warewashmg <br /> Name: Hand Sink: �2,3 `F Chlorine: 4A ppm Neat: `F <br /> Exp.Date: Warewashing Sink: °F Quat.Amm.: ppm Other: of <br /> Received By/Title: — <br /> EH Specialist: Phone: <br /> Time in: C Time Out: 2 Page f <br /> EHD 16-24 (2n0 pg) 4/3/13 J J FOOD PROGRAM OR CONTINUATION <br />