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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sicov.orgiehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: , ±r\dc-A c.f.\ c--A ,2)t-r....e vt isrA.,,,,... Date: \ - 1 —1 - -4.7:7_,
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<br />Owner/Operator: Telephone:
<br />Program Element: Program Record: Inspection Type:
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERAMO AND CORRECT! ACT ONS
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<br />Temperature
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<br />Temperature
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<br />ertificatio Facility Hot Water Temperature Warewashing
<br />Heat: °F Name: Hand Sink: ,..,, , ,,F Chlorine: ppm
<br />Exp. Date: Warewashing Sink: \ \ k.; °F •
<br />kNat Amm • " ppm Other: °F
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<br />EH Specialislae3‘.0c7v\.rsz. ....::::1 ki_N . 41101P- Phone:
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<br />Time in: 7, Time Out: --", Page of
<br />EHD 16-24 (2', pg) 4/3A
<br /> FOOD PROGRAM OIR CONTINUATION
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