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aP4yIN SAN JOAQUIN COUNTY <br />�a EOG <br />?� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />a• ;a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.ora/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: cJ-Z <br />' , r� <br />ddress: a-7aal wr <br />ry City: <br />Zip Code: <br />Owner/Operator: <br />I G <br />Telephone 16 <br />Program Element: <br />Program Record: P I CE50 ! <br />1 <br />Inspection Type: <br />8180 Posted as No <br />Permit Posted es No Re -Inspection on or After: <br />- <br />• <br />BSERVAJLIONS AND COFI IONS <br />IGS - c>YIS. <br />ctt <br />IYl <br />r <br />oeatid . <br />- ' Temperature Item /location Temperature <br />'Safety Certification <br />Facility Hot Water Temperature _ <br />Hand Sink: "F Chlorine: <br />- Warewashing NOEL <br />PPM 11 Heat: 'F <br />Name: <br />Exp. Date:arewashing <br />Sink: `F uat. Amm.: <br />PPM ther: `F <br />Received By / Title: <br />EH Specialist: 1 <br />Phone:gl,-jq_ <br />1 (0— <br />Time in: , <br />Time Out: -a <br />M Pag f <br />EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />