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SAN JOAQUIN COLIN , _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . = �P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> '�CjFO'tita <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: v1 -T f+ Date: (�- <br /> Address: City: < Zip Code: Cl <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: �� '�� 3i2 Inspection Type: �v <br /> IS 8180 Posted ❑Yds ❑ Permit Posted ❑Yes ❑I Re-Inspection on or After: <br /> 0.21 RVATIQNS AND CQ CTIVE ACT„1 S- __... . � . <br /> 1IL <br /> w <br /> ItemlL,ocation Temperature Item t Location Temperature <br /> h� wL 3.4 - Ni <br /> Food Safety Certification Ln <br /> ty Hot Water Temperature Warewashing <br /> Name: k: of Chlorine: ppm Heat: of <br /> Exp.Date: hing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> rn) �J"Vh <br /> EH Specialist: - Phone: \14 k4 1�d-U 3 <br /> Time in: J., t r Time Out: Page-2!.� S rto � <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />