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SAN JOAQUIN COUNTY <br /> p' y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.., ;P Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.siaov.org/ehd <br /> 9CIFOPi� <br /> 5 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: —2.-1 <br /> Address: `I _ S City: Zip Code: <br /> Owner/Operator: DO C Telephone: <br /> Program Element: , Program Record: ys 4 �,-i I Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: /�- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a nn <br /> �7 <br /> 2 S <br /> 3 _ � <br /> S <br /> e SCeh c <br /> ._ItemlLoc@tion .Tem erature Item f Location stf ":. Temperature:, <br /> ti0F <br /> A-i-� <br /> !F�n—k <br /> 8 — <br /> 2 � <br /> Food Safety Certificationi''� Hot Water Temperature ' '- Warewashng <br /> Name: of Chlorine: PPM Heat: ^F <br /> Exp.Date: g Sink: 'F ruat.Amm.: PPM ir <br /> ther: of <br /> Received By/ <br /> EH Specialist: Phone: y b _ <br /> �T <br /> ime in: 2 2R Time Out: ` 1 Page gf <br /> EHD 16-24 IV pg) 4/3(13 FOOD PROGRAM OIR CONTINUATION <br />