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/�0," SAN JOAQUIN COU, <br /> . �•..oma <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;•. ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; Date: <br /> Address: 22y2 C 1 City: —V`^ Zip Code: <br /> Owner/Operator: Telephone: _ a <br /> Program Element: 1 Program Record: C 2 --� 1 Inspection Type: I <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ww�z� <br /> J 11 <br /> C 1 2 cQ <br /> else <br /> �2ZAL�Zaa 61 VVI <br /> C11- -1- Iti <br /> 011x_,` <br /> kllr <br /> Item/Location Temperature Item/Location I Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: Wl <br /> EH Specialist: Phone: <br /> Time in: \1 Time Out: 12• l Page`of I <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />