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�0 .CMG SAN JOAQUIN COUNTY <br /> ° ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> e4.. ` �;P• Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: - Hand Sink: - `F Chlorine: ppm 'Heat: `F <br /> Exp.Date: Warawashing Sink: 'F Oust.Amm.: pp. Other: .F <br /> Received By!Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EH016-24 (2-pg) 4013 FOOD PROGRAM OIRCONTINUATION <br />