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SAN JOAQUIN COUN <br /> AO c�G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. �P• Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/eh <br /> 4��F0•R i� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: v <br /> Address: City: (/ Zip Code: 1 <br /> Owner/Operator: a W V1 b Telephone: / <br /> Program Element: Program Record: 0"i-316 <br /> (b Inspection Type: l � <br /> SB180 Posted es) No Permit Posted Yes Re-Inspection on or After: <br /> :....OBSERVATIONS/AND CORRECTIVE ACTIONS <br /> AU it V-"AAMI 10 I$ <br /> 4;%1 V01WA <br /> Co,tr <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Ouat. Amm.: ppm Other: F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: Time Out: 16 Page of <br /> otic l <br /> EHD 16-24 (21d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />