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0 gVIN. F 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.slgov.ora/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />S - �z <br />Date: _ <br />Z <br />Address: \1 _ 5�.b <br />�\ <br />v `\ e �� city: <br />i 1, Zip code: (Dj 5 3 <br />Owner/Operator: ,� �^ <br />0. <br />` Co <br />Telephone: <br />Program Element: <br />Program R S C) 23 <br />Inspection Type: <br />n1 <br />o� <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />AbI <br />C) YLn <br />o� <br />111UPlirature <br />III ;.Certiflca ' _:_ <br />/ ; <br />Name: Y_ <br />3 <br />Faculty, Hot _Water T_e_mperature <br />Hand Sink: � o <br />. rewashing, <br />'F Chlorine: ppm Heat: <br />., <br />aF <br />Exp. Date:: 3_ �3 <br />arewashing Sink: \ 22. <br />'F ust. Amm.: ppm <br />ther: <br />'F <br />Received By/ Title: <br />J <br />F- 1/ i (sup.) <br />T o� Mom' . <br />cKe-`• <br />EH Specialist: <br />_ ko ` \0- <br />Phone: '209 <br />0 -as <br />Time in: \ a <br />Time Out: ` -7 2 <br />Page I of I <br />EHD 1624 (2w pg) 4013 <br />FOOD PROGRAM OIR CONTINUATION <br />5 <br />