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SAN JOAQUIN COU <br /> 2 � ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq., iP Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> {iFpRi' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �,�y- Gi Date: <br /> Address: &V I � � XW414-,(V l��ity: Zip Code: <br /> Owner/Operator: N A— / Telephone: <br /> Program Element: !! Progr Record: <br /> A Inspection Type: �l�L <br /> cI <br /> SB180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> VAIA. WA <br /> 'i Gc r (,�v-t ll V <br /> ,1 <br /> JAIAM )J\jA V11 K�amlx_k"O( dNf__v au M,-w o <br /> Ol ( <br /> Ld yl'r <br /> OVtrQ <br /> lft4/41 T-41 <br /> L I A <br /> Item 1 Location Ter»perat�fr <br /> F i. Water nature. — — Warewashing <br /> rm _>. . . - �z,- t �_.. _ <br /> Name: Hand Sink: aF Chlorine: ppm (Heat: -F <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: �F <br /> Received By/Title* <br /> EH Specialist: Phone: <br /> Time in: 11 VVI Time Out: G` Page of` <br /> EHD 16-24 (2o°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />