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SAN JOAQUIN COUN <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton 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 /> SS180 Posted Yes No Permit Posted Yes No Re-Inspection on or After• <br /> Yb <br /> _ OBSERVATIONS AND CORRECTIVE ACTIONS <br /> P <br /> .a <br /> /o,� <br /> P <br /> • c.E l r- <br /> /9�6 f 4 <br /> /Z Xzw <br /> Item/location <br /> Food Safety Certification Facility Hot water Temperature warewashing „_. ': <br /> Name: Hand Sink: .F Chlorine: Ppm Heat: "F <br /> Exp.Date: arewashing Sink: 'F Oust.Amm.: ppm Other: F <br /> I <br /> eceivedH Spee' list: —.L::& Time <br /> ime in: Time Out:/ Pa�of <br /> EHD 1624 (2b pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />