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SAN JOAQUIN COUP <br /> �+ ENVIRONMENTLvenue, <br /> DEPARTMENT <br /> X <br /> 1868 East Haze lto on, A95205-6232 <br /> Telephone:(209)468-3420 F38 W :www.sigov.orcl/ehd <br /> FOOD PROGRAM OFFCT <br /> REPORT <br /> Name of Facility: Date: IC� <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> _ _..-......... T�2 <br /> A! <br /> _cGm.........................._.._ -- ---. ....... _......----- <br /> .................---- <br /> Item/Location i Temperature Item!Location Temperature <br /> Food Safety Certification ! Facility Hot Water Temperature Warewashing <br /> Name: 'Hand Sink: F Chlorine: ppm Heat: °F <br /> Exp.Date: arewashing Sink: -F Quat.Amm.: PPM Other: of <br /> Received By/ itle: <br /> -• <br /> EH Spec i list: Phone: <br /> ime in: / Time Out: Pa 2,of <br /> EHD 16-24 (2nd pg) 4!3/13 ( FOOD PROGRAM OIR CONTINUATION <br />