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'"" SAN JOAQUIN COUN,�. <br /> �. ° N <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www-slgov.org/ehd <br /> �/FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT f <br /> Name of Facility: -) Date: <br /> Address: f / City: Zip Code: �J <br /> Owner/Operator: Lr` Telephone: zlb& <br /> - <br /> 16 <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Pasted ❑Yes ❑ Permit Posted ❑Yes IT I Re-Inspection on or After: <br /> _. ;;.:.:. QSS . VATIQNS ANI ,GORREGTIVE ACTIONSI/ kA „ <br /> I IV <br /> r <br /> r <br /> ON <br /> n n <br /> . V <br /> r � � <br /> G Gtr ' <br /> l"�2 re ni r- a <br /> cty Hat Water Temperature Warewashin <br /> Name: and Sink: of hlorine: ppm Heat: "F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm Cher: of <br /> Received By I Title: S s� <br /> EH Specialist: Phone: <br /> ime in. Time Out: <br /> ` - -- � Pa9e of <br /> l <br /> EHD 16-24 (21pg) 413!13 FOOD PROGRAM OIR CONTINUATION <br />