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a"'" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.., •..;� Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' "���� Date: l tl <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> Is 6180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVATIONS AND CORRECTIVE ACTION <br /> tb <br /> e <br /> _L <br /> CTLO <br /> t0 <br /> fternALocyA Temperature Item I Location Temperature <br /> i <br /> Food Safety CertHication Facility Hot Water Temperature Warewashing <br /> Name: - - ---Hand Sink: --— F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm Other: `F <br /> Received By I Title: <br /> EH Specialist- Phone: <br /> Time in: Time Out: , �v Pag f <br /> EHD 16.24 (2n0 Pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />