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,oP4 .FA� SAN JOAQUIN COUP <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c .. m ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> 4�iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' ; Date: r;,' 1 r�r4 <br /> 711-4 <br /> Address: _ City: -%�— Zip Code: -y <br /> J '; f� <br /> Owner/Operator: �� :Telephone: <br /> Program Element: t4 Program Record: Insp ction Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> / ? / (, /' <br /> J - <br /> 1 ' <br /> 6 <br /> Tj <br /> � . <br /> Item/Location Temperature Item/Location Temperature <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: - `F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sir1k: ' °F Quat.Amm.: ppm then: o f <br /> Received By/Title: , <br /> l <br /> EH Specialist: �` Phone: <br /> Time in: ^ , 7 Time Out: J h Page/(of <br /> EHD 16-24 (2nd pg) 4/3/13 �`r' FOOD PROGRAM OIR CONTINUATION <br />