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SAN JOAQUIN COUN <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.stgov.org/ehd <br /> L��oR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: / City: Zip Code: <br /> Owner/Operator: C� 1 C Telephone: <br /> Program Element: Program Record: 7 ,? Inspection Type: <br /> SB180 Posted Yes No Y Permit Posted Yes No \/ Re-Inspection on or After: <br /> '. L +OBSERVA'�!#)NS pP1U GflRRECTIUE A T C)NS <br /> --- ..... . --------- - _......_ ....................... <br /> ....... ___- <br /> ...........__....._................... _....._�1�f___% ..._.... <br /> - <br /> �-� <br /> i. <br /> Q 'U _ ...... .. ... .. 1__..... .... Q Cc fir <br /> _._._.................................____.._.............. <br /> __ <br /> cam_- <br /> ice. At / �i <br /> itemlLocatwn Tem rature Item Locatwn Ter4rfsetature <br /> ;, l`aoit<Safety Ger�ific;�taon M �����`.-- ���Fac►lity,Ho`k W�tera3'emperature ���,�` A�"�� �re�rasMng � _'�`�,: <br /> Name: Hand Sink: ��. of Chlorine: ppm Heat: aF <br /> Exp.Date: Warewashing Sink:la7 of Quat.Amm.: ppm Other: -F <br /> Received By/Tit <br /> EH Specialist: Phone: <br /> Time in: -� Time Out: Z� Pag of <br /> EHD 16-24 (2^^pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />