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a¢RAQ,A� SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cj�_Fda�; Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: / / City: /' Zip Code: <br /> Owner/Operator: — ^ ( Telephone: <br /> Program Element: Program Record: 0,5- � Inspection Type: <br /> SB18-Posted Yes No Permit Posted Yes - No Re-Inspection on or Aker: <br /> A'.q'�7'�M� '7,$ <br /> Item!tocatiorw <br /> `Certification Facility Hot Water Temperature Warewashmli <br /> ame: — - Hand Sink: =F Chlorine: Pm Heat: 'F <br /> Exp.Date: / arewashing Sink: "F Ouat.Amm.: ppm ther: of <br /> I <br /> eceived ByH Speciali t: Phone: j <br /> ime in: �a , Time Out: Peg <br /> e7of <br /> EHD 16-24 (2-pg) 4/3113 FOOD PROGRAM OIR cows ION <br />