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• l <br /> SAN JOAQUIN COUNTY <br /> >. � •.oma . <br /> ar �� ENVIRONMENTAL.HEALT:H DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Teleph©ne:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> Lr�oe , <br /> FOOD PROGRAM OFFICIAL INSPECTIQN REPORT <br /> Name of Facility;` i7"CSZDate: <br /> Address: 1 , S � City: �� � � Zip Code: <br /> Owner/Operator: W 1 Telephone: <br /> Program Element; b� Program Record: SZ Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No 'Re-Inspection on or After: <br /> OBSERVATlaN$AND CORFiECTl1fE ACT!©NS, <br /> c <br /> E <br /> n4 <br /> Ir, S s c <br /> i <br /> ttemlLc>catiort' . �, a �,# Tempe>afsre. 3tem1'Locat+on '_..� � 1Temperature. <br /> Food Safety+Cettaf+cat+on r �„ Fac+Gty Hot ater:Temperatur—e , 'Ware_v,+ashmg J � <br /> Name: Hand Sink: 'F: Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: of Quat.Amen.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: Phone: �b <br /> i <br /> ime in: Time Out: Pag!2ff <br /> r <br /> EHE 16-24 (god pg) 4!3113 FOOL)PROGRAM OIR CONTINUATfON <br /> I <br /> i <br />