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Qe�u' •..� SAN JOAQUIN COUNT <br /> e' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> dui 3 �� Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s' ov.or /ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �` S e — �� Date: <br /> Address: n City: Zip Code- <br /> caner/Operator" Telephone: <br /> Program Element: S Program Record: S t 5 Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t2 <br /> LeA <br /> - <br /> c <br /> ltem/i_ocation Temperature item/Location emperature <br /> 12 55 - 1�� <br /> s - <br /> 2 S - - 1S — <br /> Food Safety Certlflcation, Facility Hot Water Temperature W irevl"Ang <br /> Name: Hand Sink: °F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat. Amm.: ppm Other: .F <br /> Received By/Title: L <br /> EH Speclel Phone: 2c�fn_ _b1 <br /> Time In: ^-7 :5 0 Time Out: Ot Pa of S <br /> EHD 16-24 (2nd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />