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SAN JOAQUIN COUNTY <br />?� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ad... .••.�a. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /><<FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: _ <br />tldress: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: <br />SB180 Posted Yes <br />No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />I, 1 <br />Item/Location Temperature:' <br />'I^ teirY'Ji- ation Temperature <br />Food Safety Certification _ FadlityHot Water,Te_mperature <br />_ _Warewashing <br />Name: <br />Hand Sink: <br />F <br />Chlorine: <br />PPM Heat: of <br />Exp. Date: <br />arewashing Sink: <br />-F <br />Ouat. Amm.: <br />PPM Other: of <br />Received By / Title: <br />EH Specialist: <br />Phone: j I11/1 <br />ime in: ( <br />Time Out: <br />Page of <br />EHD 1624 (2 -pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />