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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.siclov.org/ehd <br /> u�aR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> Name of Facility: <br /> Address: 11 � � 1 _ � City: de: <br /> C l _ _ t. t Zip Co <br /> Owner/operator: Telephone: <br /> Program Element: Program Record: 2� O� - Inspection Type: <br /> SBt80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r'_ <br /> 1 t - 'L <br /> Temperature. <br /> Item 1 Loca_tior Temperature <br /> item/Locatlonl��F <br /> C <br /> L ^7 _ - <br /> Food Safety Certification and <br /> Hot Water Temperature _. <br /> Warewashing ' <br /> Hand Sink. o f hlorine: ppm Heat: °F <br /> Name: <br /> arewashing Sink: of ust.Amm.: ppm ther: "F <br /> Exp. Date: <br /> Received By I TRW P) <br /> _ Phone: <br /> EH Specislist- <br /> Tlme Out: q a�1 Page of <br /> ImeIn: '1'ZS <br /> C.3 - FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2"pg) 4.!3113 <br />