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T'If <br /> SAN JOAQUIN COUN <br /> Y.' .coG <br /> ENVIRONMENTAL HEALTH DE. ,ARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �y..,• �,.a�P Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \4 INN, Date: 472 <br /> Address: rJO 5 S - I I V` City: ITC tL}7 iYl Zip Code: �n 15 <br /> Owner/Operator: `1 rl `�1 1 , Telephone: {�s—_t 12 <br /> Program Element: I�Z 1"�1•�Progr m Record: � (�G)2 b3� Inspection Type: t2q iU� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 10 1111 <br /> 1 \j v ors, (UT-1-'e <br /> u 1�a4an �- ?� PaturG Item l Location . <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amni ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 9z C4 (or„ b <br /> Time in: �0 Time Out: �J Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />