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aP4ktN. <br />e: sa <br />•..c'P[1coAi'p <br />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.siaov.orQ/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />UDate: <br />Address: <br />ity: <br />Zip Code: <br />Owner/Operator: <br />t <br />/ <br />Telephone: <br />Program Element: <br />PrUginim ec <br />Inspection Type: <br />SB180 Posted Yes <br />o <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />IWO <br />OB IONS AND CORRECTIVE ACTIONS <br />i <br />2,3 <br />ocation <br />peraturet <br />- emp8 Lire <br />•, Food Satety CertificatiW Facility Hot Water <br />Name: ` Hand Sink: qj-of�Uu­at.mm.: <br />iorine: <br />Warew _ <br />Ppm Heat: <br />of <br />Exp. Date: <br />arewashing Sink: <br />'F <br />Ppm Other: <br />o f <br />eceived By/ Title: <br />f I <br />yeZ <br />(2,01 <br />2-6I S6 <br />Specialist: <br />[EH <br />Phone: <br />]me in:.� <br />Time Out: <br />Page of <br />EHD 16-24 (200 Pg) 413'13 FOOD PROGRAM OIR CONTINUATION <br />