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SAN JOAQUIN COU <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.., �}• Telephone:(209) 468-3420 Fax.,(209)464-0138 Web:www.siaov.ora/ehd <br /> 'CI Flims~ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddress: City: Zip Code: <br /> wner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> 8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e <br /> f <br /> -- item/L� 'ature =' <br /> aS <br /> Food Safety Certification Facility Hot Water Temperature War <br /> Name: Hand Sink: ,F Chlorine: ppm t' °F <br /> Ezp. Date: Warewashing Sink: 'F Ouat. Amm.: pPm or: eF <br /> Received By/Title: <br /> H Specialist: Phone: <br /> ime in: Time Out: Pe f <br /> EHD 16-24 (2i°pg)4/y13 FOOD PROGRAM OF CONTINUATION <br />