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SAN JOAQUIN COUNTti..J <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4.. „T �` Telephone: (209) 458-3420 Fax: (209)464-0138 Web:www.sigov.orglehd <br /> Z��OR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ^ Date: <br /> Address: ,1��5 - City: Zip Code: t <br /> Owner/Operator: ` t_ Telephone: <br /> Program Element: b25 Program Record: >� -� Inspection Type:IS <br /> B180 Posted G Yes ❑ Rermit Posted ❑Yes U I Re-Inspection on or After: <br /> f-U-N Y <br /> C l(- ` <br /> 1�5 rhe _ sem}, 'S1. 'ti s, aSe 1-e Wit- •�� -z <br /> fterntLocatfon t77, <br /> # 1 �' ►' TermperetIAM <br /> Fcx�d ife?y" _;• ai ftt # NSI r Ware+irasWng <br /> Nam Hand Sink: of Chlorine: 41'pppm Heat: .F <br /> O <br /> Exp.Date: Warewashing Sink:1 2_b of Quat. mm.: ppm ther: of <br /> Received By I Title: <br /> EH Specialist: - Phone: <br /> time in: l Time Out: "1,C51 C Page of <br /> EHD 16-24 (21d pg) 413113 J F000 PROGRAM OIR CONTINUATION <br />