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°"�" SAN JOAQUIN COUNTY <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.•: .�;;P Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 3 <br /> Address: i f' � City: Zip Code: <br /> Owner/Operator: �_ Telephone: <br /> Program Element: Program Record:/+ ? 3 /'�1 Inspection Type: �. <br /> 8180 Posted El Yes ❑ Rermit Posted C� ❑7Yes ❑dl ' Re-Inspection on or After: <br /> INS! I <br /> ASSISI <br /> ✓�/ ` . il <br /> I ` <br /> .td A 4.KW-_t- 4- 4 <br /> -7 lye <br /> 06A,Ofd -rki <br /> Awl cwvjfko�VA Coy" <br /> Item/Location Temperature Item]Location Temperature <br /> Facility Hot Water Temperature . ,; Warewashing <br /> Name: _ Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Ti le: <br /> EH Specialist: VPhone: <br /> Time in: Time Out: �� Page Lf <br /> EHD 16-24 (2n1 pg) 4,3113 FOOD PROGRAM OIR CONTINUATION <br />