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SAN .10AQUIN COUNTY <br /> �° �o <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4..• �;�P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjggov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: ` w \ -�- City:i Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: `l^� Program Record: So (��A Inspection Type: <br /> SBI80 Posted Yes No Permit Posted Yes No Re-Inspection on or Afte . <br /> CA <br /> M P cj_- � ' <br /> 1r-er� <br /> 3 -t4-e <br /> 2 <br /> Temperature Item 1 Location Te m p e raeullre <br /> t— <br /> \ \ X11F 2c �x cam. 3� 1— <br /> � 15Z <br /> x d d afe :Gertif catio Facility Hot Water Temperature Warewashing <br /> Name: \� ^ Hand Sink: v 1, of Chlorine: ppm Heat: 1 of <br /> Exp.Date: S c _V��Zy arewashing Sink: ? `J of uat.Amm.: ppm Other: of <br /> J � <br /> Received By I Title: <br /> EH Specialis Phone: y 1_b <br /> Time in: ,2+ 22 Time Out: Pag of -' <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />