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SAN JOAQUIN COUNTY <br /> a` ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.r... = ;P Telephone:(209)468-3420 Fax: (209) 464-0138 Web:www.sioov.oro/ehd <br /> 9��F�RN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Ahvjt�jDate: <br /> Address: City: Zip Code: <br /> caner/Operatord r` Telephone: --W— <br /> Program Element: 71,jj. Program Recod: . t,;'v Inspection Type: k , <br /> 8180 Posted Ye No Permit Posted Yes No V Re-Inspection on or After: ' r7 1/,� <br /> EC.T1E ACTto �` <br /> !'i r/ N ✓ Yl J <br /> kid <br /> e ✓ <br /> ✓ 2 <br /> Thtu_ a' <br /> t <br /> re <br /> Wat+✓U <5W)�k an&i D — rVrrdt e--4i n t <br /> dYhl K IJ nc� r 12 <br /> I Food Safety Certification Facility Hot Water Temperature "` .t Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: -F <br /> Exp.Date: arewashing Sink: of Oust.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: rr11�L Phone: <br /> imein: ` Time Out: � ` Page if <br /> EHD 16-24 (2-pg) 4PNI3 FOOD PROGRAM OIR CONTINUATION <br />