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;ona .go` SAN JOAQUIN COUNTY <br /> Q' Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> �l FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ZZ Date: <br /> ddress:2 City: Zip Code: <br /> wnerlOperator: Telephone: <br /> Program Element: Program Record: ��` Inspection Type: <br /> 6180 Posted ❑yes <br /> ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS, . . <br /> } <br /> er�'c \ M <br /> u l ­iS - C <br /> '7S0o OF + <br /> I, <br /> rJ <br /> 3 \ - <br /> ee I <br /> 1 fes\ \ P <br /> mel �'�N <br /> N.- ,.. . ::: item jWtion Temperature <br /> ame and Sink:_ --. °F hlorine_. . .PPM Heat:.... °F <br /> xp.Date: arewashing Sink: °F uat.Amm.: PPM ther: °F <br /> Received By I Title: - <br /> H Specie li Phone: <br /> 2- <br /> Time <br /> ime in: 1,^ 2.'�. Time Out: ��` Pag f <br /> EHD 16-24(2^^pg) 413113 JV FOOD PROGRAM OR CONTINUATION <br />