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SAN JOAQUIN COUNTY <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s"gov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: --7 - 1 — <br /> Address: �[�t^ City: Zip Code: A <br /> Owner/Operator:J`U Telephone: "l <br /> Program Element: 1 Z Program Record: i Cj Inspection Type: <br /> 6180 Posted `lJ ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> zs <br /> 3: <br /> 5 <br /> r«{y <br /> r If \ cit-• \ <br /> l <br /> r�� c <br /> r <br /> r <br /> ASA-? . <br /> S'3\_) 1 bq F �_1 - <br /> \AN — <br /> v 3'3 `-i <br /> \ - b �1 ► 1 2 <br /> F <br /> Item I Locattotl°: Temperature <br /> 0A D - <br /> \c__* 2c�, �11� t2 <br /> t Food SafetyCertification w — <br /> :'•; , . '''rarewa,hing <br /> #tfyk#ut Water''#'emperature �f Warewashing <br /> Name: V w\� _#_ nk. \ v� 'F Chlorine: i pp�n !Heat: 'F <br /> Exp. Date: Sink: o uat Amm.: Other: <br /> } L 1 F ppm 'F <br /> Received By/Title: \ "� <br /> EH Specialist: Phone: y b ^� <br /> ime in: 1+ Time Out: 2112.) <br /> Pagel of <br /> EHD 16-24 (2n,pg) 4i3%13 FOOD PROGRAM OR CONTINUATION <br />