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SAN JOAQUIN COUN <br /> q` `X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c.., - :P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siclov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q,� �.f— c1 Z M C Date: iZ <br /> Address: L,40,0 City: Zip Code: <br /> Owner/Operator: - Telephone: <br /> Program Element: 9 95- Program Record: --� Inspection Type:40 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> Y <br /> f <br /> 4— y ll <br /> 47 ' <br /> Item/Location Temperature Item#Location Temperature <br /> 4 sir/ <br /> F <br /> " Facility Hot Water Temperature Wa rewash!ng <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPm Other: of <br /> Received By/Title: <br /> EH Specialist: ( Phone: S-2 <br /> Time in: Time Out: Page of 7— <br /> j <br /> �j L— <br /> EHD 16-24 (2nd pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />