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aR°H'"• SAN JOAQUIN COUNTY <br />1 �S'FA <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />4.,, ,... Telephone: (209) 466-3420 Fax: (209) 464-0138 Web: www.sigov.ora/ehd <br />CI F01N <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />b <br />Date: lil, 77971 <br />Z <br />Address: v ,rte <br />IV <br />- <br />�� City: <br />Zip Code: <br />Owner/Operator: <br />Q�� <br />Telephone: <br />Program Element:'Program <br />Record: Z S S �� <br />Inspection Type: <br />B180 Posted - Yes No Permit Posted <br />Y s No <br />Re -Inspection on or After: <br />IQ <br />Item/Location <br />Temperature <br />Item! Location 71OWMire <br />Food Safety Certification <br />F <br />Facility Hot Water Temperature. <br />Warewashing <br />Chlorine: Ppm Heat: <br />"F <br />Name: Hand Sink: eF <br />Exp. Date: <br />arewashing Sink: <br />'F <br />Oust. Amm.: PPM Other: <br />'F <br />Received By / Title: <br />EH Specialist: <br />r <br />Phone: <br />Time in: I -A <br />Time Out: q V1, <br />Page f <br />EHD 1624 (2m pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />