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SAN JOAQUIN COU Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f t Date: 75 <br /> . 1 <br /> ddress: 3 g, City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: / „/� Program ecord: 2 Inspection Type: r� <br /> 6180 Posted 11' Yes ElRermit Posted 4" es ❑1 Re-Inspection on or After: <br /> gm <br /> Was <br /> e, <br /> Y <br /> n \ <br /> Item/Location Tempera{ture '' ;•. location Temperature <br /> 1/� -1 1 <br /> LI/ <br /> eywm <br /> v - F �1 <br /> Food Safety certification ` �°`� Facility Hot Water Temperature �717 <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: ' <br /> EH Specialist: \ Phone: <br /> Time in: 114 r� Time Out: Page of <br /> EHD 16-24 (2.1d pg) 4/3/113/ FOOD PROGRAM OIR CONTINUATION <br />