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4HIN. SAN JOAQUIN COUNTY <br /> p, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.c .. :p• Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.s_jgov.org/ehd <br /> 4Ci'aiS'k�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facillty: Date: �L3 <br /> ddress: IVlw City: Zip Code: <br /> �f✓�' <br /> Owner/Operator: Telephone: <br /> Program Element: ll I. Program Record: 62 S Z Jq Inspection Type: <br /> B180 Posted Yes No Permit Posted es No Re-Inspection on or After: <br /> t l ( — n c I e L•C t I/Ol Gl fi-x � <br /> VKL <br /> vt ! <br /> &14f jAyR ac( VL �' bkGt Gtr <br /> W*rGV ✓ IVl t�VIVIU " - <br /> Il17 G N <br /> 14 <br /> .CerNNcett cllity Hot Water Temperature - Warewashing <br /> Name: Hand Sink: �F Chlorine: ppm Heat: -F <br /> Exp.Date: arewashing Sink: -F Ouat.Amm.: ppm ther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime In: Time Out: �� U' Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />