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ons IN. SAN JOAQUIN COL": -Y <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4...... . -�" Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: DOL V Cap, b 70' Date: <br /> Address: (e0I QU -R ` PN` city: f0h zip code: 95'1-1 I <br /> Owner/Operator: /1 'ti + Telephone: al46-22-6 t1 <br /> Program Element: 1(02-3 P o ram Record: P O Z 27 (O Inspection Type: <br /> 8180 Posted Yes S No Permit Posted Yes 0 No Re-Inspection on or After: <br /> jbw YYt0.i <br /> r1p e-e m <br /> 1 'LLL Y U + LYt a Y L zedio <br /> ter v rn ra 12-4 <br /> � Iapw rr7 ���ry Z..e rn CS r <br /> Y <br /> Y- <br /> r <br /> r 3 -A CQ r p+- <br /> Adw �S <br /> a CIO r «,o CQ r 36 <br /> U <br /> Facility Hot Water' emperature Warewashirtj <br /> Name; - Hand Sink: `F Chlorine: ppm Heat: of <br /> Exp.Date. �_ J. arewashing Sink: -F O .Amm.: PPM Other: =F <br /> Received By/Title: �%YI <br /> EH Specialist: • Phone: <br /> ime in: d:O Time Out: Ji7 �` ` =�ne <br /> K —i <br /> EHD 16-24 (2"pg)4/3/13 FOOD PROGRAM OIR CONTINUATION <br />