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,Qg . oG SAN JOAQUIN COUNTY <br /> H .x ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> ame of Facility: Date: <br /> ddress: City: Zip Code: <br /> ner/Operator: Telephone: <br /> Program Element: ,� . 1 Program Record: Inspection Type: <br /> B480 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVATIONS AND CORREC;7VE„ACTIONS <br /> k <br /> smlLoa ?,; Temperature Item 1 Location Temperature <br /> .L. <br /> Food Safety Certification, R Facil6,Hht Water Temperature Warewashing <br /> Name: Hand Sink: r "F Chlorine. ppm Heat: 'F <br /> Exp. Date: arewashing Sink: 'F uat.Amm.: ppm Other: °F <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (21d pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />