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,%we SAN JOAQUIN COUI ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: r <br /> Address: , City: Zip Code: <br /> caner/Operator: D �elephons:. 3 <br /> Program Element: if Program Recorda Inspection Type: <br /> B180 Posted yes - No Permit Posted Yes No Re-Inspection on or After: <br /> RREG E ACT ; <br /> G Q <br /> ZAA- wr A-4111 'AD ' 3 <br /> pcGb- <br /> +• - Food Safety Certification _. rH <br /> cility HotWater Temperature WarewashinName: Sink: 41�1 ? -.F Chlorine: ppm Heat: of <br /> zp.Date: ashing Sink: D �F Ouat. Amm.: ppm Other: =F <br /> LSpeclalist: <br /> Title: <br /> Pho O -0-� <br /> Time Out: f�' Pa of <br /> v <br /> EHD 16-24 (2-pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />