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SAN JOAQUIN COUNTY <br /> � •.OG <br /> .Z� 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 /> �/FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - Date: — <br /> ddress: 2 2 City: � Zip Code: c <br /> Owner/Operator: Telephone: 32 <br /> Program Element: S Program Record: '� ZSR Inspection Type: 1 <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS , <br /> M w <br /> � Itettttem/tacaTemperature ?eme.nature','. <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ` Phone: r07 <br /> Time in: V Time Out: t i ' kA Pag of <br /> EHD 16-24(2ntl pg) 4/3113 "1 FOOD PROGRAM OIR CONTINUATION <br /> J <br />