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oeRNI�. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �,A/FUPN�p.• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.oro/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: el Date: .� <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Z 4� Inspection Type:7e 7 <br /> BI SO Posted Yes No Permit Posted Yes No Y Re-Inspection on or After, <br /> I ,Z 3 <br /> g &IS YE. C ION <br /> C.e r r C2 LE <br /> a <br /> se�k4 ( �iP/3 Gt2 C <br /> - -n <br /> S TW71i W� - <br /> - o� r <br /> 3 L s_ <br /> xI <br /> Item/Location - Temperature -� -m- on' <br /> Food Safety Certification Facility Hot Water Temperature _ Warewashing.i, <br /> :Name-. =dl Hand Sink: oR Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: aF Oust Amm.: ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: v /I ', r Time Out: N, 2Page of <br /> EHO 16.24 (2° Pg) 4/3/13 /-* FOOD PROGRAM OIR CONTINUATION <br />