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ok(AWN o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ;P.. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> 00 <br /> Owner/Operator: 1 Telephone: <br /> Program Element: 'Program Rec — Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> s <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rI 02 - <br /> V.;- 1 <br /> f <br /> v� <br /> g r <br /> ` � S <br /> D S <br /> - <br /> t <br /> 4K- <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> N— - — <br /> ame: Hand Sink: of Chlorine: ppm Heat: -F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: -F <br /> Received By/Title: _ <br /> EH Specialist: Phone; 4 30S2. <br /> ime in: <br /> Time Out: `; f, Page of <br /> I FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2"l pg) 4/3/13 <br />