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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •. ;P Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 4��FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: T ` Date: <br /> Address: / �! City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: �� 5 Program Record: Inspection Type: <br /> S13180 Posted es No Permit Posted A11*s No Re-Inspection on or After: <br /> QBSERVATiflNS AND CflRRECTIV�AC�QNS. <br /> T . G <br /> :item�Lacatacn Temperature Item?Location femperature <br /> _ _w.. <br /> Faod Safety,fertifiCtion r .k Faclrty Hat Water Temperature_ w; -� 1Narewashing <br /> , .- . _ <br /> Name: ` Hand Sink: /��j r 'F Chlorine: ppm Heat: nF <br /> Exp.Date: y arewashing Sink: rJ� a 'F Quat.Amm.:�`�/G_ Other: 'F <br /> Received By/Title- <br /> EH <br /> EH Specialist: Pho . <br /> Time in: �U . Time Ou : Page,of <br /> EHD 16-24 (2n°pg) 4!3113 FOOD PROGRAM OIR CONTINUATION <br />