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pu�N SAN JOAQUIN COUNTY <br /> �oP .caG <br /> r. ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 4640138 Web:www.s ov.or /ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: (,_ <br /> Name of Facility: <br /> City: ` Zip Code: c� e <br /> ddress: ;1`` } 5 J <br /> Telephone: <br /> wnerlOperator: �� <br /> g <br /> Program Element: <br /> Program Record: Inspection Type: <br /> B180 Posted G Yes ❑ Rermit Posted G Yes ❑I <br /> Re-inspection on or After: <br /> i <br /> �y i�:.o �' � �{: 'Ft�rt�� >��: 7'e►nperatur;s <br /> Z v� 113 ._ CY uCr Y <br /> H c 1 :, � �er'� iso star ras�tti� <br /> Name: Hand Sink: aF Chlorine: ppm Heat: "F <br /> Exp.Date: Warewashing Sink: ' of Quat.Amm.: ppm Other: 'F <br /> Received By I Title: Atw <br /> EH Specialist: r --Q Phone: - — <br /> time in: Time Out: 2'. 1 5 Page of <br /> FHD 16-24 (2^ pg) 413113 FOOD PROGRAM OR CONTINl1ATION <br />