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,oPa�; .coG SAN JOAQUIN COUP! <br /> 4 `a ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.si(iov.or /q ehd <br /> <<FOKa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 9 <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: / Program Record: p Q� Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS ANDRRECTIVE ACTIONS, <br /> ....................._.-.................... <br /> -- ---- -------.........._........ _......_...- <br /> ��:__ 7 , . <br /> ._........... <br /> ���—moo� � � •a y i�� �P� . � o------ <br /> .......... <br /> (f rr l s i i :" emperature �-Item 7;Locationz Temperature <br /> FouflSafeyt Gert{f;Ctlort .acility HotVl►ate_r ;em rature ashmg , <br /> Name: 1-2� Hand Sink: -F Chlorine pm�Heat: of <br /> Exp.Date: Warewas��ing Sink��� of Ouat.Amm.: ppm Other: of <br /> /D: <br /> Received By itle: <br /> EH Speciali t: Phon <br /> ime in: �� Time Out: b/, Page f <br /> -cHD 16-24 (2n°pg) 413/13 r FOOD PROGRAM OIR CONTINUATION <br />