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o�pu,rK" c SAN JOAQUIN COUNTY <br /> 7."c�F •.pG <br /> e` \ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•. �� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br /> �ii b.f+t <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> wner]Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> IS 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes U. I Re-Inspection on or After: <br /> DBSERVATIONS AND CORRECTIVE ACTIONS <br /> i � J <br /> 1 CA- - C - <br /> C <br /> ?O - i_'- /N- 1 C <br /> 21 Q-ko <br /> - I <br /> S <br /> 2Z <br /> I Temperature <br /> •_.�a - - - _ - <br /> Name: and Sink: 'F hlorine: ppm Heat: "F <br /> Exp.Date: arewashing Sink: "F uat.Amm.: ppm Other: 'F <br /> Received By 1 Ti e: I <br /> EH Specialis Phone: <br /> Time in: , 1 , Time Out: �9 Page` f <br /> E-ID 16-24 I21 pg) 4iY13 FOOD PROGRAM OR CONTINUATION <br />