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SAN JOAQUIN COUNTY <br />a` ? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />41FO�N <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 />6180 Posted Yes <br />No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />r <br />fit, <br />Temperature <br />Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperat <br />Name: Hand Sink: <br />_ _ Warewashing <br />aF chlorine: ppm Heat: 'F <br />Exp. Date: <br />arewashing Sink: <br />`F Ouat. Amm.: ppm <br />Other: 'F <br />Received By / Title: <br />EH Specialist: I <br />` U VVI i <br />Phone: <br />Time in: i <br />Time Out: S Page. of <br />EHD 16-24 (21' pg) 41x3 FOOD PROGRAM OIR CONTINUATION <br />