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SAN JOAQUIN COUNTY <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c..• _ �P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> q�/FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: '7 <br /> ddress: 1 City: —r Zip Code: q <br /> Owner/Operator: Telephone: 3 3 _clO s <br /> Program Element: Program Record: S 000 Inspection Type: -24-,.CA.- <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: (2-p <br /> mss^^ --"" �.:.� <br /> ,y$ ` ''e 4 a �, ` -�,f1:•: _ ^` - ° E 71id �0 $ - r y <br /> 1 n :ice. kJ_ <br /> 04�k Ls <br /> \\ S . <br /> S <br /> leo Cf V41 <br /> �. 1� c n ha.re s v or _ <br /> 3 s <br /> 1 <br /> ` <br /> 2,r\& (e <br /> 0-S- t- <br /> b-N- � . <br /> to -oic )on _v . _ J T6niperatuee <br /> -, \ .�•� � -1-o r,�--Qty <br /> Food Safety Certification Facility Hot Water Tempera re Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: :S <br /> EH Specialist: P ne: 3 <br /> Time in: , Time Out: + 1 ZS Page lof 0. <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD <br /> PROGRAM OIIR CONTINUATION <br />