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ptaN'!" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'clov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility � Date: _ z 0 <br /> Address: � 00 <br /> C r 1 city:`(0"_ Zip Code: S <br /> Owner/Operator: Telephone: <br /> Program Elemgnt: q Program Record: Soy Z ,5 7<S c)-A iD Inspection Type: <br /> L82posted El Yes ❑ No Permit Posted []Yes ri No Re-Inspection on or After: <br /> OBSERV.AT,I,ONS AND CORRECTIVE ACTIONS <br /> J J i <br /> 1 <br /> Vo - t O C <br /> Itemll-ocation Temperature Item I Location Temperature <br /> Food Safety Certification IL <br /> Hot Water Temperature ; Warewashing <br /> - - - -- - <br /> Name - - — "F Chlorine: ppm Heat: aF <br /> Exp.Date: ng Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: - <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page, Hof L f <br /> EHO 16-24 (2ntl pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />