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a4,PA .,pA� 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.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: / a <br /> ddress: 1 City: Zip Code: <br /> Owner/Ope ator: b, N Telephone: <br /> Program Element: Program Record: V h Inspection Type: <br /> SE180 Posted Yes o Permit Posted Yes No Re-Inspection on or After: I 2 <br /> . Z, <br /> " SERVATIO - CORRECTI _ v� <br /> V I c-e' <br /> / <br /> d W �✓/'h 11/ti � <br /> L <br /> L A,-2! ✓ <br /> I yo F— <br /> ac -ga <br /> mm <br /> .e <br /> VS r <br /> ✓a , ,( <br /> Ow' ) Ir2 <br /> Food Safety Certificaff ,acility Hot Water Temperature Warewashing <br /> Name: and Sink: F Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: 'F Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: 'O �- <br /> EH Specialist: I,�-{ Phone: <br /> line in: I yk <br /> Time Out: Pag off <br /> EHD 16-24 (2nO p9) 4/3/13 b FOOD PROGRAM OF CONTINUATION <br />