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oP4�iN..� SAN JOAQUIN COUNTY <br />' 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 />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: <br />SBI80 Posted Yes No <br />Permit Posted Yes No <br />Re -inspection on or After: <br />AMMOM <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />IU <br />ovation <br />Temperature <br />` /Location Temperatq._ <br />_ Certification <br />Facility _Hpt.Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of <br />hlorine: ppm <br />11c <br />Heat: of <br />Exp. Date: <br />arewashingSink: <br />'F <br />Quat. Amm.: ppm <br />Other: =F <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />ime in: <br />Time Out: 'I �� V Page of <br />EHD 16-24 (21° pg) 4/3/13 FOOD PROGRAM CIA CONTINUATION <br />