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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Edi/FdR+p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />- �. <br />Date: 101 <br />a-1 <br />Address: 1 -p5^ .. W 1 1+,. <br />- City: <br />Zip Code: <br />Owner/Operator: _� ' In <br />Telephone: <br />Program Element: 6 2 <br />Program Record: Q 5 <br />Inspection Type: <br />,ham <br />SB180 Posted YNo <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />s nb <br />COR <br />BSERVATIO ANDR1101511 <br />A <br />t <br />t <br />%3 Q <br />'Item / Location <br />tLie_ <br />Fa <br />Food Safe Cerdli _, <br />Name: krhS l7V, <br />acility Hot Water Temperature-. <br />and Sink: <br />Warewashing „ <br />ofChlorine: ._ ppm Heat: <br />=F <br />Exp. Date: 2 D ZS-� arewashing Sink: 1 33 <br />of <br />Oust. Amm.: OD ppm Other: __ <br />=F <br />Received By / Title: <br />2Q <br />EH Specialist: <br />Phone: <br />Time in: Z , <br />t. 16AJ <br />Time Out: I I <br />Page of <br />EHD 1644 (2'° Pg) 4/313 FOOD PROGRAM OR CONTINUATION <br />