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SAN JOAQUIN COUNO <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4.. _ :P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si-gov.org/ehd <br /> �IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r t 0't4 Ai Date: <br /> Address: ) City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: y, Program Record:_` Z7 <br /> Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OE <br /> �. Lae q= <br /> f <br /> Kbon F=- if, ��g4N!fs. <br /> t © <br /> --- - <br /> Item/Location -7 Temperature Item/ tIoIn "' Temperature <br /> /ti14 <br /> -------------- <br /> -— - ---- <br /> Food Safety Certification Facility Hot water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: �� Page <br /> EHD 16-24 (2'd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />