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oPA�IN•.c SAN JOAQUIN COUNTY <br />? ENVIRONMENTAL HEALTH DEPARTMENT <br />a: < <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />�raa� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />OS <br />��� S <br />r LP—s jDate: <br />2 <br />�Z 3 <br />Address: <br />/ <br />!/ <br />City; o Zip Coda: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: 0 S <br />Inspection Type: <br />u <br />SB180 Poste <br />No <br />Permit Poste <br />Yes No <br />Re-Inspectlon on or After: <br />� <br />a <br />Item/Locafion <br />- Temperature <br />Item l Location <br />Temperature <br />s <br />am; <br />civ <br />—�6 <br />Food <br />Safety Certification <br />Facility Hot Water Temperature Warewashing <br />Name: <br />Hand Sink: 1 <br />L <br />H <br />D =F Chlorine: ppmVA eat: <br />=F <br />Exp. Date: <br />arewashing Sink: <br />eF uat. Amm.: ppm ther: <br />o f <br />lved By/ Title: — <br />iV <br />cgp'%'/pecialist. <br />[,a <br />- <br />Phone: <br />In: I <br />/I/I <br />Time Out: 1-� ; s� <br />i7 <br />Page of <br />HAD 16-24 (2n0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />