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SAN JOAQUIN COUNTY <br /> y, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �a.. a;p. Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.orgfehd <br /> LIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address, City: Zip Code: <br /> Z <br /> Owner/operator: Telephone: <br /> Program Element: / Program Record: C1 - Inspection Type: <br /> SB180 Posted Yes No, Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Z r <br /> tAll i t <br /> r e <br /> r <br /> f & s <br /> t <br /> l <br /> LS" <br /> i t / / �t ✓a.c <br /> ItemlLocation Temperature Item 1 Location Temperature <br /> _ I <br /> t2Wj&fetY Certi, t3 Facility Hat Water Temperature Warewashing <br /> Name: Hand Sink: �F Chlorine: ppm Heat: `F <br /> Exp. Date: Wamwashing sink: 'F Quat.Amm.: ppm (Other. 'F <br /> Received By/Title: <br /> EH Specialist: , Phone: ` _ U Z <br /> ime in: Time Out: Page of <br /> EHD 16.24 (21d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />