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oP4"'N.c' .S.'AN 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.si4ov.orCl/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /� Date: <br /> Address: City: Zip Code: /50 <br /> r <br /> Owner/Operator: Telephone:•iyR-.qs'�— , <br /> Program Element: Program Record: Inspection Type:.' ` <br /> �q I <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> BSERVATIONS C W CTI., S <br /> & S' . <br /> no v <br /> w i � <br /> Item/Location Temperature Item/Location Temperature <br /> ........... <br /> Food Safety Certlflcatlo Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: r - <br /> Time in: J ; Time Out- '�/) ��j-� Pag f 1. <br /> EHD 16-24 (211 pg) 413113 v FOOD PROGRAM OR CONTINUATION <br />