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SAN JOAQUIN COUY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ca.. ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 to4vh ,-' i,r/ Date: Z �� <br /> Address: •' L4— City: Zip Code: <br /> Owner/Operator: Telephone: �— <br /> Program Element: Program Record: +U�l Inspection Type: 1q <br /> SB180 PosteN1 Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> 011' O(,l Yw� rvH wi ►•�.t.t��-�-,� <br /> c� <br /> Wy-y J4 <br /> Item/Location Temperature Item I Location Temperature <br /> ,� �`F S exy',Ceitification �� <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: �V,(2 ---- --- Phone: <br /> Time in: l i Time Out: Page?of <br /> V J <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />