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P0, SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q... -.a;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: <br /> Address: City: ip ode: <br /> O /I:i <br /> Owner/Ope ator: Telephone: <br /> Program Element: Program ecord: , Inspection Type: l/ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rl <br /> CPvzo/v / <br /> r1 b <br /> 4, <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: eF Quat.Amm.: ppm Other: of <br /> Received By/Title: /- <br /> EH Specialist: Phone: <br /> ime in: �^ Time Out: - Page of <br /> EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OIR CONTIN ATION <br />