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PSAN JOAQUIN COU. <br /> *>0, .coG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c�.. :P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slQov.orq/ehd <br /> t1 FORS' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: D atm t � ?Ave r Date: � A <br /> Address: 1-I S � � �� I City: t�'+�`�&.M, yr )sZip Code: <br /> L <br /> Owner/Operator: M.� SG�Grld Telephone: <br /> Program Element: G i `� Program Record: d l� U Inspection Type:/ Tv <br /> SB180 Posted VYes ❑ No Permit Posted I Yes No Re-Inspection on or After: W Q�rs <br /> 2 Z <br /> �u cern Carl <br /> �il in <br /> QPS <br /> 0 0 136 dlri2lA Qin 1 r i S q� 44 °F <br /> .e law �d <br /> ' 3 d r TNZ, to e 40- Qt Ta `e t -is, ufi . PC� ki- <br /> i� <br /> �z i Ci- rd -�DO by 1166 01N yrs MOnt I Uhd n <br /> V <br /> rA0 hander i .&q xN is Me \vm . NOT was <br /> -Sclm-r� kvcv1- Co- haW4-� 200' tr\ Cb\C'T`100 <br /> Item/Location Temperature Item t Location Temperature <br /> — — ------ _.._— ......... L <br /> 1 - -+Oa F <br /> trul-sYa 0 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 4 Phone: I <br /> Time in: 1 . kPI,j Time Out: Page�of• <br /> EHD 16-24 (2"d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />