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rcA <br />F\ SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: <br />Address: City: Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: Program Record: Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />_ <br />_) -- <br />\ 1 2-- (1 (2, , .- <br />- <br />-. --c k <br />i I 1, 5S ct <br />, ), <br />Item/Location Temperature Item / Location- „Vilnlir-7'IstaiwTemperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: o F Chlorine:°F ppm Heat: <br />Exp. Date: Warewashing Sink: . Quat. Amm.: ppm Other: °F <br />Received By / Title: <br />'C '-- \,-- \-\ c)r\ <br />EH Specialist: '''''' - ‘ \ Phone: <br />`Jr-i- i _ <br />Time in: Time Out: \ 0 ' ‘ ')Page of <br />EHD 16-24 (2^, pg) 4/3/13