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p4a"In•.o SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c•.• iP• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s'gov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _L Date: ,,, ' <br /> Address: IIty: G A Zip Code: <br /> 14 2A 'To <br /> Owner/Operator: (! Telephone: <br /> Program Element: Program Record: Inspection Type• tj <br /> SB180 Poste No Permit Poste es No Re-Inspection on or Aft : <br /> RVATIONS AND CORRECTIVE ACTIONS <br /> JV <br /> C <br /> v <br /> ocation_ ,... .._pere, -. <br /> 2 F <br /> 11'• 004p fety.Certifice ' FacilityHotWaterTemperature Warewashing_ <br /> Name: and Sink: aF Chlorine: ppm 11 Heat: -F <br /> Exp.Date: er are as ingSink: -F Ouat.Amm.: ppm ther: 'F <br /> Received By/Title: <br /> EH Specialist: ",//Yl Zye� Phone: <br /> Time in: Time Out: Page of <br /> EHD16-24 (2ropg) 4IN13 FOOD PROGRAM OR CONTINUATION <br />