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SAN JOAQUIN COUIa,,.,, <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.s'gov.ora/ehd <br /> L1FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: S/ <br /> Address: S City: Zip Code: <br /> Owner/Operator: / Telephon .'5�6 <br /> Program Element: Program Record: U Inspection Type: <br /> SB180 Posted Yes a-?Irf Permit Posted Yes -Acr Re-Inspection on or After: <br /> D3RREGTJVJ� F75 . mti ;tYr <br /> �e <br /> Item/Location Aa� Temperature Item!Location 1 Temperature <br /> I <br /> l <br /> Food Safety Certification -; facility Hot water Temperature 2- .,. ;shins <br /> Name: Hand Sink: `F hlorine: PPM Heat: `F <br /> Exp.Date: a arewashing Sink: -F ruat.Amin.: PPm Other: "F <br /> Received By R <br /> EH Speciast: Phone:/ ��J <br /> Time in: 5R- TimeOut: 9 Pag of <br /> EHD 1624 (2b pg) 4013 FOOD PROGRAM OR CONTINUATION <br />