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SAN JOAQUIN COUNTY <br />? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />o... ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />9�iFoaN <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 />SB180 Posted Yes <br />No Permit Posted Yes No <br />Re -Inspection on or After: <br />1(Pt'1,r 4, <br />W&MOKYATIONS AND CORRECTIVE ACTIONS <br />L( <br />ItemfLocation <br />Temperature <br />Item ! Location <br />Safety Certification <br />Facility. Hot Water Temperature <br />Hand Sink: <br />'F <br />Warewashing' <br />Chlorine: ppm Heal: <br />"F <br />Name: <br />Exp. Date: <br />arewashing Sink: <br />of <br />uat. Amm.: ppm ther: <br />°F <br />Received By/ Title: <br />�. <br />EH Specialist: <br />Ime in: <br />Phone: <br />Time Out: <br />Page of <br />EHD 1624 (2n4 pg) 4/3'13 FOOD PROGRAM OIR CONTINUATION <br />