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pAqurH SAN .IOAQUIN COUNTY <br /> 5. .COG <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.s'qov.org/ehd <br /> Z1FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` Date: 1'z <br /> Address: p City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: a5 7_ Inspection Type: <br /> SB18O Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 <br /> L ,rf DX <br /> y cam- <br /> on Temperature Item/Location Temperature <br /> Facility Hot Water Temperature. Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: `F uat.Amm.f ppm they: 'F <br /> Received By <br /> EH Specialis : A Phone: <br /> Time in: 0 Time Out: 0r C Page7of > <br /> � <br /> EHD 1&24 {Zt pg] 41T13 FOOD PROGRAM OIR CONTINUATION <br />