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SAN JOAQUIN COUNTY <br />gyp........ C <br />i ENVIRONMENTAL HEALTH DEPARTMENT <br />_ - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sagov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:Date: <br />3 <br />Address: 2"4 City r <br />Zip Code- <br />01 <br />Owner/Operator: <br />Telephone: <br />Warewashing <br />ppm Heat: of <br />Program Element: 1 02 Program Record: S l— <br />V `❑CYYes <br />Inspection Type: <br />arewashing Sink: 1 <br />6180 Posted ❑ Yes ❑ Rermit Posted ❑ 1 <br />Re -Inspection on or After: <br />t M U lb -L4 IZ° pg) 41Jn3 FOOD PROGRAM OR CONTINUATION <br />MSM <br />1 `O <br />Food Safety Certification Facility Hot Water Temperature °� <br />Name: Hand Sink: of 'Chl i <br />Warewashing <br />ppm Heat: of <br />Exp. Date: <br />arewashing Sink: 1 <br />of <br />Quat. Amm.:ppm <br />ther: of <br />Received By / Title: <br />EH Specialist: IPhone: <br />Aa <br />IOU <br />Time in: <br />Time Out:1 <br />Pageof <br />t M U lb -L4 IZ° pg) 41Jn3 FOOD PROGRAM OR CONTINUATION <br />MSM <br />1 `O <br />