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avin SAN JOAQUIN COU"..; <br /> r. Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> T .1 <br /> a: < <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •oq'�iFORN1P• <br /> Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.sigov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - Date: <br /> Address: City: Zip Code: <br /> wner/Operator: - Telephone: <br /> Program Element: S Program Record: - Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> LjQjfi§fflWIONS AND CORRE . ff ACTIONS <br /> z ,� <br /> -"d Safety -e kation Facility Hot Water Temperature Warewas. <br /> ame: Hand Sink: "F Chlorine: PPM Heat: of <br /> Exp.Date: arewashing Sink: - �F Ouat.Amm.: PPM Other: OF <br /> Received By/Till . <br /> EH Special) -- Ph e: / <br /> ime in: Time Out: Pa of <br /> EHD 1624 (2-p9)4013 FOOD PROGRAM OIR CONTINUATION <br />