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SAN JOAQUIN COUN , Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4., adv Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> L%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facilit Date: <br /> LI - j <br /> Y' = 4 u h °�c�,, h h r ,vI 'f <br /> Address: S c:, c4 I City: I Zip Code: 2 5 2 0 6 <br /> Owner/Operator: Telephone: <br /> ZC' <br /> Program Element: Program Record: Inspection Type: <br /> C:A • � <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> .. .. ..............-.. <br /> OBSERVATIONS AND CORRECTIVE ACTIONS., <br /> _ vi S <br /> X<' Co vs'I --- <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ISS• 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: / r Time Out: Page of <br /> EHD 16-24 (2^ pg) 4/9/112 J FOOD PROGRAM OIR CONTINUATION <br />