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SAN JOAQUIN COUN . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..., .�;;P Telephone: (209)468-3420 Fax: (209)464-0138 Web:uvww.sipov.orq/ehd <br /> <iii w <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C cjA Date: I <br /> Address: I C City: \}�,G�L_t-,,� Zip Code: C� <br /> < V v` 1 v 1 cJ <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: C occ) C y-b 5 Inspection Type: <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> V Yih S &e in Vvi Cin G Ou..p <br /> 1 n JY ► CI <br /> Item/Location Temperature F Item!Location Temperature <br /> Safety Hot Water Temperature Warewashing <br /> _.. _ <br /> 7Name: Hand Sink: of ',Chlorine: ppm ;Neat: nF <br /> 7 arewashing Sink: of Quat. Amm.: ppm Other: of <br /> Received By/Title: i0 <br /> EH Specialist: Phone: <br /> ime in: q �J Time Out: 1, �O Page I of I <br /> 1 <br /> EHD 16-24 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />