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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.siqov.orcilehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility:•'"That.\(, _4_1(..\a;•\c"r\ C\ '‘, 1--....Q., Date: I — 1---/ . 23
<br />Address: City: Zip Code:
<br />51-9 2,
<br />Owner/Operator: Telephone: 4
<br />Program Element: Program Record: Inspection Type: N
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
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<br />Item/Location Temperature Item Loc
<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: oF Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: .F ()oat. Amm.: ppm Other: °F
<br />W4
<br />Received By / Title: j% Q_).3 64-(
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<br />•• Phone: 2L..)9 b i b_
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<br />Time in: 9-ne-N
<br />Time Out: Page of
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<br />EHD 16-24 (2^d pg) 4/3/113
<br /> FOOD PROGRAM OR CONTINUATION
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