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SAN JOAQUIN COUP` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sipov:olrg/ehd <br /> ;r>•'dde� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 30 <br /> Address: City: � Zip Code: <br /> OwnerlOperator: Telephone: <br /> ja <br /> Program Element: Pr gram Record: Inspection Type: <br /> V6­1 <br /> Pasted ❑Yes ❑ Rermit Posted 0 Yes DI Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I <br /> 11A ra 4 <br /> 1, f <br /> Item/Location Temperature item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Band Sink: OF hlorine: ppm Heat: OF <br /> Exp.Date: Warewashing Sink: OF uat.Amm.: ppm Other: OF <br /> Received By 1 Title: ' <br /> EH Specialist: f T Phone: <br /> Time in: Time Out: r - Page of <br /> EHD 16.24 (21 1 pg) 413113 l FOOD PROGRAM OR CONTINUATION <br />