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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r clFetia p Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: fC�' J Date: <br /> Address: City: zip Code: <br /> i I <br /> Owner/Operator: Telephone: <br /> Program Element: ! !_ G -program Recor /_5Inspection Type: L' I e <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVATIONS AND CO E TIV ACTION- " <br /> F <br /> Ca W4 <br /> l tJ l <br /> I <br /> PQ <br /> crl <br /> Ite' ocation ` <br /> `[ DN r <br /> N/0 I/ Irte _,•, "rL Li 0 F �3-4-f= <br /> aciBty,Hot Water_Temperature -. Warewashing,, <br /> Name: and Sink: I of hlorine: zo Ppm Heat: -,_• `F <br /> Exp.Date: arewashing Sink: I 2r 'Frust.Amm.: ppm ther: 'F <br /> Received By/Title: '! I L 10 Y 1 Crt,n t/i-l✓� <br /> EH Specialist: ` llPhone: 2® ^ / (/ — 3Df2- <br /> Time in: 2 )0Time Out: •o Page of <br /> EHD 1644 (2b pg) 413113 FOOD PROGRAM OR CONTINUATION <br />