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oP4�I�•. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.oro/ehd <br /> ti€dA`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 777 <br /> Address; S © W City: Zip Code: <br /> Owner/Operator: a��^ �/ 'Q,f Telephone: <br /> Program Element: Program Record: �S Z— Inspection Type:ic <br /> B/80 Posted Yes No Permit Posted s No Re-Inspection on or After: <br /> BSERV IONS AND C CTI E ACTIONS, <br /> opt seri � ;' <br /> ffjff <br /> C Grl9 <br /> r <br /> l S� i ZOZ <br /> e' <br /> 3DArF <br /> rl lnl <br /> Li <br /> -ood Safety certifi_catio_nFacility Hot Water Temperature Warewashing _ <br /> rE <br /> me: - / Hand Sink: / J eF Chlorine: ppm Heat: of <br /> p.Date: I I' Q ' arewashing Sink: ZQ 'F uat.Amm.: PPM Other: =P <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: (-) , 15 <br /> Time Out: Page <br /> EHD 1&24 (2ne pg) 4W FOOD PROGRAM OM CONTINUATION <br />