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SAN JOAQUIN COUN— <br /> `� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> w'P <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> 4c1k6`A � <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i Date:V <br /> u o c TlC 12.20-/ ' <br /> Address: / i City: lr0.t Zip Code: <br /> Owner/Operator: Telephone: j <br /> 8�3 5- <br /> Program Element: Program Record: Inspection Type: <br /> B180 Posted _. es No Permit Posted _. es ❑ No Re-Inspection on or After: <br /> G ilc ci,11 c ,s <br /> x <br /> Food Safety Certification Facility Hot Water Temperature: . Warewashing <br /> Name: Hand Sink: "F Chlorine: PPM Heat: 'F <br /> Exp. Date: arewashing Sink: 'y -F Ouat.Amm.: PPM Other: -F <br /> O <br /> Received By/Title: <br /> H Specialist: - Phone: <br /> .7 _ ___ Yf70 V <br /> Time in: / Time Out: '; 4S P89 <br /> e2 of <br /> EHD 16-24 (2-39) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />