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SAN JOAQUIN COUNO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • c... �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> 9GjFORi� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — Date: / <br /> Address: �7 � / ,(�j City: Zip Code: <br /> Owner/Operator: _ Telephone: <br /> Program Element: Program Record: nD �� ction L L�— `lv� <br /> SB180 Posted Yes C No Permit Posted Yes No Re-InsVection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> < /V/ �h <br /> s �- <br /> eace_ l D r, 7-0// <br /> kkt(A(el - war /ileOGa-te ol <br /> �e c oc <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification rility Hot Water Temperature Warewashing <br /> Name: Hand Sink. of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: I <br /> Time in: i 71 Time Out: •J Pag of <br /> EHD 16-24 (2n1 pg) 1112109 FOOD PROGRAM OR CONTINUATION <br />