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op4N!(r,,c . SAN JOAQUIN COUNTY <br />2< ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />r,•...,p , ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.ora/ehd <br />�IFORN <br />�wti.�A' j PdJ1 <br />Ir00 4R)GR n ee OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: .yt <br />6-v <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: ,t7 <br />Set 80 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: V <br />l0 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />jQf_A_,S <br />1u <br />jtktt_u rj U 291La- <br />�o ' <br />Q. <br />bs <br />6k CAP,- -t� <br />V <br />c - ca A& <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />'F <br />Chlorine: PPM <br />Heat: <br />aF <br />Exp. Date: <br />arewashing Sink: <br />"F <br />Ouat. Amm.: PPM <br />Other: <br />of <br />Received By/ Title: <br />EH Specialist: <br />Phone: <br />Time in: <br />(� <br />Time Out: ('! <br />Page. of <br />EHD 16-24 (2b pg) 4&13 FOOD PROGRAM OIR CONTINUATION <br />