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PQu�" SAN JOAQUIN COU Y <br /> 4 � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �1 poR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , ` Date: t <br /> Address: h City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: P ogram Record: /� SZ- 7Q 3 Inspection Type: <br /> SB180 Poste Yes No Permit Posted Yes No Re-Inspection on or After: "vV <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ..... -- <br /> __ ___----- ---...--..........._. - - <br /> a�- <br /> Item/Location i.;TemperatureItem I Location i Temperature <br /> Z� <br /> 1a- <br /> Food Safety Certification Facility Hot Water Temperature itA e vashmg it <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: / arewashing Sink i of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: _ Phone: �S <br /> Time in: 2 Time Out: ► Pagg of <br /> EHD 16-24 (2-pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />