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SAN JOAQUIN COUNTY <br /> ?-ate•�o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cdL�kdR�';a• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` �fn Date: !L <br /> Address: M �{ 4ww City: Ul Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: �� ! Program Record: 1�7.or I Inspection Type: <br /> FB18_0Posted Yes No I Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND ARE TIONS <br /> !/V\ <br /> r g <br /> f 1 (Aj <br /> fdo <br /> be pJet— <br /> G <br /> ItemlLocation _ 7"nal:u � Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: F iChIorine: ppm Heat: of <br /> Exp.Date: g F . ...... ppm °F arewashin Sink: iQuat Amm.: Other: <br /> Received By 1 Title. <br /> EH Specialist: Glv� I Phone: <br /> Ime in: E,�� Time Out: Page of <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16.24 (21d pg) 4013 <br />