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C, SAN JOAQUIN COUN <br /> Z� 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.sigov.org/ehd <br /> '9L/FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: To } Date: I Z� �,1-7a <br /> Address: 3 City: 5L_ Zip Code: gr.__� <br /> Owner/Operator. ���G Telephone: '�s�'� <br /> Program Element: Program Record: .� Inspection Type: <br /> SB180 PostedNo Permit Posted a No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> A L <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: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: - Time Out: OV Page of <br /> N <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />