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g4'n• SAN JOAQUIN COUNTY <br />? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />ad... P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: <br />6180 Posted Yes <br />No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE <br />ACTIONS <br />tirf <br />— <br />Item/Locatlon Temperature <br />Food Safety Certlfleation <br />Facility Hot Water. Temperature <br />Warewashing. <br />Name: <br />Hand Sink: <br />of <br />Chlorine: <br />ppm <br />Heat: of <br />Exp. Date: <br />Warewashing Sink: <br />of <br />Quat Amm.: <br />PPM <br />Other: of <br />Title: <br />Eeceived <br />Phone:i <br />Time Out: I <br />Page of <br />EHD 16-24 (Z' pg) 4/3173 FIXID HHueHnM um <br />