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Y <br /> aPq 'N• SAN JOAQUIN COUNTY <br /> a <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4tiddr�;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S Date: <br /> ddress: r City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: 6 Z Program Record: fr(,1 / Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No J ! C7 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t7 Y S� SAAM S Z <br /> Elm ff� v W_�� <br /> i <br /> 5 I�10 <br /> 0 d u <br /> a <br /> �' f 9:' /✓r�°+» � /0 /'��� G1 i /CLQ <br /> tern/Location Temperature Item/Location Temperature <br /> Food Safety Certification FaciBty Hot Water Temperature - Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: PPM ther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime In: Time Out: Page oft <br /> EHD16-24 (2nOpg) 4013 FOOD PROGRAM OIR CONTINUATION <br />