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oPA"'"•. SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�•... ;v Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.orD/ehd <br />'crFaar <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: ,I <br />3ZZ z <br />Address: <br />City: Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: ;l <br />3 <br />Inspection Type: <br />l� <br />B180 Post Yes <br />No <br />Permit Posted s No <br />Re -Inspection on or After: <br />S' <br />OBSERVATIONS AND CORRECT .E ACTIONS <br />ZZA <br />6� <br />/ <br />L <br />(i <br />r <br />iC l21 <br />7 perature <br />= <br />Facility Hot Water Temperature <br />Warewashiat: <br />� <br />Name: <br />Hand Sink: <br />of <br />Chlorine: <br />ppm <br />Heat: <br />of <br />Ezp. Date: <br />arewashing Sink: <br />of <br />Ouat. Amm.:ppm <br />Other: <br />-F <br />Received By Title <br />EH Specialist� <br />Phone: <br />Time in: . <br />Time Out < <br />it _ --7> <br />Page of <br />EHD 16.24 (2ntl pg) 4IT13 FOOD PROGRAM 01R CONTINUATION <br />