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SAN JOAQUIN COSY <br /> ?, ENVIRONMENTAL HEALTH DEPARTMENT <br /> - :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-523 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.oro/ehd <br /> tlFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Q Date: 2 Name of Facility: <br /> City: Zip Code: <br /> Address: S <br /> Telephone: <br /> Owner/Operator: U � V a <br /> Program Element: '06 <br /> 0D Program Record: ( v ()0 4 c�.�-Gj Inspection Type: C� �� <br /> 5Biw Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> flBSRVATF31N L3RRECTiVE AG71�3NS <br /> - <br /> 2 CUaC Gt rU 2 <br /> ftemlt�attoi�, ,< ,v ,...'CE�w`�Turs t:oc8t�or} 7ernpeiature <br /> Food Sgfet Cer#iffcation:, �artu#3r;ldot Water T�>�peratur�; 1iVarevvashirig. <br /> Name: Hand sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm ther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: 00 1 <br /> ime in: I 4 Time Out: 12 Pag of <br /> 1 1 FOOD PROGRAM OIR CONFINUA719N <br /> EHD 16-24 (2'"pg) 4/3113 <br />