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SAN JOAQUIN COUNT'. <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/ehd <br /> 9C/FpRia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: � Date: ?—_2 3.- c�l1 <br /> Address: w rinA _ /� City: Zip Code: <br /> Owner/Operator: Telephone: u/ <br /> i <br /> Program Element: Program Record: 1;` Inspection Type: , <br /> SB180 Posted es o Permit Posted es No J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> V <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> -if� � r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: c Hand Sink: 0 a of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: ! -F Quat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: � Time Out: Page of <br /> u <br /> EHD 16-24(2^d pg) 4/9/12 Y t` ; FOOD PROGRAM OR CONTINUATION <br />