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a"'"• SAN JOAQUIN COUNTY <br /> a a� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.CC{��FdAN�P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.orD/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: IM)S Date: / <br /> Address: �+oO 7 City: (� Zip Code: 3J <br /> Owner/Operator: 'O J Telephone: l(lp_ 0 <br /> Program Element: (O 23 Progra ecord: � DS' 13 S' Inspection Type: h O <br /> 8180 Posted Ye No Permit Posted a No Re-Inspection on or After: <br /> OBSERV 10 S IONS <br /> rrwrz'�C If 4 � < <br /> "'Ot— V/ 2L/77f-7 <br /> eo <br /> � r <br /> 3 �sC�Ui si <br /> n <br /> s ct)r r? w <br /> sslr� 2_Z c� <br /> Item/Lo <br /> Food Safe Facility Hot Water Temperature <br /> Name: - Hand Sink: of Chlorine: ppm Heat: eF <br /> Exp.Date: arewashing Sink: vF Oust.Arnim.: ppm ther: of <br /> Recelved By/Title: <br /> EH Specialist: Phone: _ O <br /> ime In: Time Out: Page/Of/ <br /> EHD 16-24 (2' Pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />