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Zip Code:City: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Record:Program Element: <br />Re-Inspection on or After:NoPermit Posted YesNoYesSB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />TemperatureItem / LocationTemperatureItem/Location <br />Food Safety Certification <br />Chlorine:Name:°Fppm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:°F°F PPm <br />Received By/Title: <br />Phone:EH Specialist: <br />Page ofTime Out:Time in:A <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2"dpg) 4/3/13 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orq/ehd <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Food Program Official Inspection Report <br />Date: <br />Facility Hot Water Temperature <br />Hand Sink: