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SAN JOAQUIN COUNTY <br /> a ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sioov.org/ehd <br /> ��FokN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: i 3 <br /> Address: I ` City: Zip Code: C <br /> Owner/Operator: a,, 1 inTelephone <br /> 9M <br /> Program Element: C Program Record: Inspection Type: <br /> 6t BD Posted es No Permit Posted es, No Re-Inspection on or After: N <br /> OBSERV, D CORR i <br /> k 1 � <br /> n <br /> Ife on - �Temperature Item/Locatio <br /> -Food Safety Certificate"-- Facility Not Water Temperature -_ warewashing <br /> Name: Hand Sink: F Chlorine: ppm Heat: "F <br /> Exp. Date: arewashing Sink: 'F oust.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page44of <br /> EHD 16-24 (20 pg) 4013 O`` FOOD PROGRAM OR CONTINUATION <br />