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SAN JOAQUIN COUNTY <br /> r. 'y ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �"•. a Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.sigov.or0/ehd <br /> 't cl ad'A?• <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: t 0.O 1 1 ` CtyrT <br /> Zip Code: <br /> Owner/OperatoVr: Telephone: <br /> Program Element: Program Record: Inspection Type: T` <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: T` <br /> Item/Location i Temperature-. <br /> 3 f 1�ee - 1F -- - <br /> ._- tl" a#efy Certification '.` �acitit Hot Water - --- 1.-- <br /> _ Temperature -i� rewashing <br /> Name: 'Mand Sink: ,F Chlorine: ppm 'Heat `F <br /> Exp.Data�:_� !Warewashing Sink: -F Ouat.Amm.: _-- PPM Other: "F <br /> Received <br /> ``By/TitleEH : Ifir <br /> Specialist: _ - _ Phone: <br /> Time in: 't• Time Out: O g <br /> Pa of <br /> EHD 1624 (2^ pg) 4/3113 FOOD PROGRAM olR OONTINUATION <br /> 5 <br />