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oP4�1N• c SAN JOAQUIN COUNTY <br />r ` ENVIRONMENTAL HEALTH DEPARTMENT <br />P: -1 <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />a.., p. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.oro/ehd <br />4�FOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />- <br />Ad—dress: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />6 / <br />Program Record: O�•'7 -yr q <br />J a <br />Inspection Type: P r� <br />SB180 Posted Yes <br />No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />Q <br />o <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />J <br />.;<., Food Safety Certification <br />Facility Hot Water Temperature?.' <br />. Wwaviashing <br />..:......: <br />Name: <br />Han d Sink: <br />of <br />Chlorine: ppm <br />Heat: <br />of <br />Exp. Date: <br />arewashing Sink: <br />of <br />Ouat. ppm <br />Other: <br />of <br />Received By / Title: <br />/- <br />EH Specialist <br />– <br />Phone: <br />Time in: <br />q I g Am <br />Time Out: I • /� ��y� <br />Page oto <br />EHD 16-24 (2ntl pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />