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p. " SAN JOAQUIN COUN' <br /> O .....,. C <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �/FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT , . <br /> Name of Facility: k Date: <br /> Address: /� /,, /V City: Zip Code: <br /> Owner/Operator: V f/V f Telephone: 3 �' <br /> Program Element: Pr gram Record: Inspection Type:C� <br /> 8180 Posted !/ ❑Yes ❑ Rermit Posted ❑Yes ❑ 1 Re-Inspection on or After: <br /> � r <br /> OBSERVATIONS AND t6kREICTIVE ACTIONS <br /> xt <br /> K C <br /> cam . <br /> �` C c Y►� L' Cx <br /> ..�4 WI VI W07 0-iy a/V, <br /> ✓tom <br /> ✓�G <br /> . Temperature Items I Location Temperature' <br /> Warewashing <br /> Name: Hand Sink: of hlorine: ppm Heat. of <br /> Exp.Date: n arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: _ <br /> Time in: Time Out: Page! of <br /> EHD 16-24 (2nd pg) 43113 , FOOD PROGRAM OIR CONTINUATION <br />