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SAN JOAQUIN COUNTY <br />p .. <br />z. y ENVIRONMENTAL HEALTH DEPARTMENT <br />- = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.�FOR�:- iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.org/ehd <br />� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: <br />City: Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />`` L <br />t ��G1 <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />I <br />i <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of <br />Chlorine: ppm <br />Heat: of <br />Exp. Date: <br />Warewashing Sink: <br />of <br />Quat. Amm.: ppm <br />Other: of <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />Time in: <br />Time Out: Page of <br />EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />