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j ops =k SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> ZIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 2— <br /> Address: i 2 C City: Zip Code: <br /> Owner/Operator: J Telephone: <br /> Program Element: Program ecord: S� Inspection Type: <br /> St <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> flPE L V I TFC3AIS AN Ci RRECTI 4-PO <br /> M - <br /> 1 <br /> IEtn >:.... T erafure, Et�.�:t�ocatln dem erature <br /> Fbo sa#ety Cert �cetlop,,: Facility alai YVater Teitiperature. V!►ar�vitastsin <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> _.- ._------ <br /> __..... ._. __ <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received T• <br /> EH Speci is : Phone: \ 1 _ 0 <br /> 3 <br /> Time in: Time Out: ` • Page of <br /> EHD 16-24 (2nO pg; 413'13 FOOD PROGRAM UR CO TiNUATION <br />