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SAN JOAQUIN COUNTY <br /> %a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ~ ;P Telephone:(209)468-3420 Fax.(209)464-0138 Web:www.sogov.org/ehd <br /> ,�rFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A Date: /77/037/ /7 <br /> Address: A1fi n City: Zip Code: <br /> Owner/Operator:V " n AllTelephone: <br /> Ot <br /> Program Element: 0� Program Reco S Inspection Typ <br /> SB180 Posted Yes No Permit Posted Yes No Reinspection on or After: <br /> .i lXM hIj <br /> i'1t <br /> q <br /> / W <br /> InN <br /> -- <br /> Item/Location Temperature Item/Location Temperature <br /> 33F <br /> M <br /> Food Safety Certification Fa ility Hot.Water Temperature.. Warewasfiing <br /> _ . a--- _..._- - - <br /> Name: Hand Sink: F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: =F Oust.Amm.: ppm Other: -F <br /> Received By/Titl <br /> EH Specialist: Phone: 0 — /es _ <br /> Time in: L 14 L4 <br /> Time Out: Page of <br /> FOOD PROGRAM OIR CONTINUATION <br /> - EHD 16-24 (2^ pg) 0113 <br />