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P°"'" <br /> �o.�.pSAN JOAQUIN COUNTY <br /> oG <br /> y� 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 /> gc;FaRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C l Date: /2' j <br /> Address: City: Zip Code: <br /> Owner/Operator: /� L�01 �— Telephone: r �© <br /> Program Element: G'f Program Record: Inspection Type: <br /> SBI 80 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-inspection on or After: <br /> t. <br /> ,i <br /> Gl <br /> Gt Yl <br /> Z <br /> rwctt— vow( f <br /> Item/Locaion, Temperature Item/L c do Temperature Item/Locatiigill� e <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ) { of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing ink: .I of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Pageof <br /> EHD 16-24(21"pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />