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r <br /> SAN JOAQUIN COUNTY <br /> ` ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c9�li oR��P Telephone:(209)468-3420 Fax:(209)464-0138 Web:WwW.siaov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` Date: _ <br /> ddress: \ v�` \ U�� Ci (U Zip Code: q S3 <br /> Owner/Operator:�J Telephone: <br /> Program Element: Program Record: <-::�,-A U S Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> 002-?_S 2G Z o �S <br /> e c <br /> 2� l7cc r1� <br /> \ems c� ' n ec ►�S�-P �- 1-e_ <br /> r' a.�-e_ -fir rr-2. e w �� <br /> e � l <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: '��Z� L 1 . � ' U Z <br /> EH Specialis;: � � _ �\� Phone: <br /> Time in: Time Out: Page. of <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />