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oPQur� <br /> �.. .cd SAN JOAQUIN COL,""�Y <br /> Q <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y 1868 East Hazelton Avenue, Stockton, CA 95205-6202 <br /> o Telephone:(209) 468-3420 Fax-(209) 464-0138 Web: WAA <br /> 'Q�•1 F' Rt`�P <br /> +gov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility; <br /> Address: �1 �' O <br /> Date: <br /> Owner/Operator: City: Zip Code: <br /> G <br /> Program Element; Telephone: <br /> W,�� L' Program Record: p �J f � <br /> SB180 Posted Yes No 1� l Inspection Type: <br /> Permit Posted Yes No 4C Vs <br /> Re-Inspection on or After: <br /> QBStRVA��P.C i3F3 :T1 It t t ONS. <br /> Jl <br /> C 1t IS d terc i h el a <br /> Ll <br /> �--�1 1 3 <br /> itet�zl csCati,drt -, ��nper$ture 'Fr j{L-pca'ii n, Temperatpte <br /> Foast'Safe£y ert catioli .rCi tty HotWatet T� er�t ire Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: o f <br /> Received By/Title: +U <br /> G� Y <br /> EH Specialist: Phone: / <br /> ii <br /> Time in: Time Out: Page of <br /> FHD 1E-24 {21a pg} 413!13 FOOD PROGRAM UP CONTINUATION <br />