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Pqu�N SAN JOAQUIN COUP <br /> : � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: h ,(E / LL. Lt: ( Date: {� 3 <br /> Address: City: L � Zip Code: <br /> Owner/Operator: in/rL { Telephone: <br /> Program Element: u Program Record: d Inspection Type: <br /> SB180 Posted Yes No Permit Posted -Yes I_ No Re-Inspection on or After: C <br /> ask- <br /> PLO <br /> S Wv mryvx <br /> rA14t n wa_-tz� <br /> cd oil <br /> CL Cie 04, <br /> ltem/L�cafian ' Temperature Item/.Location mperature <br /> C <br /> ......... . ----_- <br /> 4 U�' �- Aug- lv <br /> I t 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: 1 <br /> EH Specialist: rye Phone: <br /> Time in: Time Out: Page2of 2 <br /> 7D 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />