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(444DO <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: I <br /> Address: City: Zip Code: <br /> Owner/Opera or: Telephone: el O O <br /> Program Element: low Program Record: YJ t1l Inspection Type: �n( <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: N V1 <br /> VATIO. CT,LY ►T <br /> u �GD �kt L+- IS III <br /> e <br /> n m i yr i at, �n _ ► en. <br /> Item/Location i,, -�%fipeieEu�ev "" tet6/Locati` - emperature <br /> Food Safety Certification .acility Hot Water Temperature V Warewashing: <br /> Name: Hand Sink: =F LuatrLAmm.: <br /> ine: ppm 11 Heat: of <br /> Exp. Date: arewashing Sink: eF ppm Other: =F <br /> Received By/Title: <br /> EH Specialist: hone: I �� <br /> Time In: n I I Time Out: 1 PageZf <br /> EHD 16-24 (2" pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />