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SAN JOAQUIN COUN`� <br /> ENVIRONMENTAL HEALTH DEPARTMENT µ <br /> _ • 1868 East Hazelton Avenue, Stockton, CA 95205-6232 I <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd_ € <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 11 <br /> Address: /o,/ �� n' City: Zip Code: <br /> i <br /> Owner/Operator: 4/5, <br /> � Telepho <br /> Program Element: /tea Progr ecard: Q`, inspection Ty i fl <br /> 8180 Posted Yes No Permit Posted Yes No y Re-Inspection on or After: <br /> F <br /> s. �QSE IA' t0, s N��'i�1Ft 'T�4i� AGTI��I <br /> 4� VIJ�/• /Q J E•5 <br /> i <br /> r I� <br /> � l <br /> X3.3 <br /> 7 <br /> - ,1te�/t�afio � . :=T�ernperat�r� o . '" ��L�cai�csn .. �Tetiperatt5re e :E <br /> tea- - . ... _ � .. .. ...��.� . ,:• ���� _ �,, -.. : <br /> ;_ Fnod,Safa Cfiica�on �;'p,�`= i=ei „f^IotVIr79t�r�ern era#ut'� YVar�vash�n�; <br /> Name: Hand Sink: °F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm they: 'F <br /> ti <br /> Received By 1 Title• Y AA A3(FC?i <br /> EH Specialist: Phone �Q <br /> ~� Time Out: Page f <br /> Tim,in: C�•�., <br /> FOOD PROGRAM OR CONTINUATION <br /> EHD 1 fi-24 (2ntl pgJ 413113 ,; <br />