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• aPag"• SAN JOAQUIN COUNTY <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • o4C1Foa��p.• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 61C, Date: <br /> Address: a-541 b& City: _] -Vpt"j zip Code: J�Y <br /> Owner/Operator: Telephone: Y <br /> Program Element: '� Program Record: jJ Inspection Type: <br /> SB180 Posted Yes o Permit Posted Yes No Re-Inspection on or After: N1 1 <br /> TIONS AND (-nRRFr..TIVF ACTIO <br /> [ , <br /> was m <br /> Cum <br /> ki e - <br /> \m.e <br /> Yernperature <br /> M i <br /> F <br /> Facility Hot Water Temperature Warew <br /> Name: Hand Sink: ;, LL) <br /> �F Chlorine: PPM Heat: =F <br /> Exp.Date: arewashing Sink: •J of Oust.Amm.: ppm Other: of <br /> Received By/Title: I Y� <br /> EH Specialist: Phone: — <br /> Time In: Time Out: •2 � of u� Pag <br /> EHD 16-24 (2-pg) 4/3/13 's <br /> FOOD PROGRAM OIR CONTINUATION <br />