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SAN JOAQUIN COUN <br /> Z., ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cR.• a�P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> L%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \j\ :1 �_ Date: } ` <br /> daress: 2�t �- _ �� City: v Zip Code: �- 2 Ob <br /> Owner/Operator: r Telephone: <br /> Program Element: Pro am Record: Inspection Type: <br /> SB180 Posted ❑Yes ❑ Permit Posted ❑Yes OF Re-Inspection on or After: <br /> 19015, <br /> l <br /> -� : i <br /> s <br /> Item!Locatran ,,.�„ �� ",r r E Temperature <br /> meter Temperature 3ir�revuashing <br /> �� U <br /> Name: \I Hand Sink: - °F Chlorine: ppm Heat: °F <br /> - arewashing Sink: 2 ° Qua .Amm.: pp Other: <br /> Exp.Date: F m °F <br /> Received By/Title: <br /> EH Specialist: Q Phone: <br /> Time Out: "\ l Pag of <br /> Time in: �, ZS <br /> EHD 16-24 (2otl pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />