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""" SAN JOAQUIN COUNT. <br />a ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />�%FORM <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: <br />City:' <br />Zip Code: <br />�J <br />Owner/Operator: <br />Telephone: <br />Program Element: 16 <br />r— Program Record: 70 <br />U <br />Inspection Type: <br />B180 Posted Yes <br />No Permit Posted -Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Alf <br />Ff_ <br />F it <br />OIL <br />IV <br />OL <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of <br />Chlorine: <br />ppm <br />Heat: <br />of <br />Exp. Date: <br />Warewashing Sink: <br />of <br />Ouat. Amm.:ppm <br />Other: <br />of <br />Received By/ Title: <br />EH Specialist: <br />Phone: <br />2- <br />Time in: <br />Time Out: <br />A --i <br />Page of <br />EHD 16-24 (2" pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />