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SAN JOAQUIN COUNTY <br /> r ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M Date: g <br /> Address: -Z 5(/ City:s O Zip Code: <br /> Owner/Operator: Q�j A 'dZr- I0.u os ,,n Telephone: �c�O^gJS <br /> Program Element: ` O / Program Record ^ SZ3 '�C_J Inspection Type: p <br /> B181t Posted n Yes 11Rermit Posted !..' n Yes ❑1 Re-Inspection on or After: <br /> n1164 /Vg <br /> r a W <br /> d ' r'-S ca r i ✓l O ex. <br /> " r <br /> , mf <br /> D e ^ a <br /> O <br /> � P 4 <br /> ar <br /> Item/Location Temperature item/Location Temperate,' <br /> r, <br /> �e�etrr� rr ;sew• 2 <br /> Food Safety ipcation F ciiity Hot Water Temperature - Warewashing <br /> Name: -� S -' _ - Hand Sink: ' 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: / 3- 0 <br /> 3 p 202 1 arewashing Sink: "F uat.Amm.: ppm Other: F <br /> Received By I Title. �\ Cq ; ^` <br /> EH Specialist: p > Phone: /J 49"-63;_7i <br /> me in: 3 3 V^, Time Out: Page of <br /> EHD 1624(2^^pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />