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SAN JOAQUIN COUNTY <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 8 a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.oro/ehd <br /> 4Ci sE't1N: <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: Clty: Zip Code: <br /> Owner/Operator: 'Telephone: <br /> Program Element: Pro rem Record: Inspection Type: r <br /> 8180 Posted Yes No Permit Posted Yes No -I coon on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS' <br /> n <br /> r <br /> C <br /> 117 <br /> --------------------------- <br /> Item/Locati <br /> Food Safety Certificati _ Facility Hot Water Temperature i -WarewaLLA <br /> Name: Hand Sink: -F Chlorine: PPm Exp. Date: Warewashing Sink: 'F uat.Amm.: PPm <br /> Received By/Title: .�C "'LoZ— 19 <br /> EH Specialist: c. - Phone: 2 Q <br /> Time in: Time Out: t Page of <br /> EHD 16-24 (2n°pg) M3113 FOOD PROGRAM OIR CONTINUATION <br />