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SAN JOAQUIN COUNTY <br /> ?a 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 /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility. Date: <br /> Address: , e•' City: Zip Code: —1 S <br /> Owner/Operator: Telephone: <br /> b5p-22y 3 �j <br /> Program Element: ` Program Record: t Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> EEF�WOBSERVATIONS AND CORRECTIVE ACTIONS <br /> S 22� <br /> C_?Llng� 4�_ <br /> _Qj 0-1:* <br /> c <br /> Item/Location perature =- it /Locatio w- Temperatu <br /> 2 - t31 <br /> 2 <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: 1 _ arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: �. , cJ; _ I <br /> EH Specialist: Phone: b <br /> Time in: 1 Q� -tom Time Out: ) Page`of <br /> EHD 16-24 (2nd pg) 413/13�V FOOD PROGRAM OIR CONTINUATION <br />