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SAN JOAQUIN COL <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> LiFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C/K Date: -IS <br /> Address: C/ -c, City: ��=-�h Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: yro Program Record: P IQ 12 O Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No 1�:'r' ;. �?,y Re-Inspection on or After: <br /> QBSERVATtflN 'z AIflRRECTtV „CTtONS x <br /> u r _------ � C l tldt �i-� �l/liY t/h.(� LtJ-Q–ene--e 7 J . __........ ..._...................-............_......_.._. <br /> LAI or.& Yeso Cye c/ <br /> . _.......................................... <br /> .�p r� _. manci5�✓ (S� rr� ._.... �.cJ �. W�z � <br /> c,ura ro ya CB fi --- e.....L{..._..._....- <br /> ... r-,4S fro c� m y-Lc�,S.�+-�� Gz[-{,l <br /> 6R fs _ <br /> itemlLacation„ Temperature .,' : Item 1.1ocation ,� erSii�elature <br /> Qpd 58fe Ger�firatlon : �ci HotWater Tem rature Vllarewashing <br /> ty., dY.... U -- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: °F <br /> Received By!T' <br /> EH Specialist: Phone: <br /> — --------- -- ---- <br /> Time in: Time Out-: Page of r <br /> EHD 16-24 (2^^pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />