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oPau1"• SAN JOAQUIN COUNTY <br /> .pA ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4.-.. ...yro Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'oov.org/ehd <br /> �IFdtta <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 2] <br /> ddress: City: Zip Code: <br /> Owner/Operator: , / Telephone: <br /> Program Element: Program Record: Inspection Type: r wt <br /> 8180 Posted Yes No Permit Posted Ye No Re-Inspection on or After: <br /> BSERVJ11216 919495 E:111911010 <br /> .�— <br /> IAAA�f 14 (Al" <br /> ( I <br /> U n--7 OA <br /> t o aN <br /> Gt((a ( Uva ,1V-e 01 WA(V--&1 <br /> V„ ' . <br /> c `u— W � u <br /> enAim a e t c 3 <br /> eYnperature <br /> W I � ✓► / <br /> ha ►^e 'c . — <br /> Facility Hot Water Temperature <br /> Name: Hand Sink: �F Llote: ppm Heat: of <br /> Exp.Date: arewashing Sink: of mm.: ppm they: =F <br /> Received By/Title: <br /> EH Specialist: Phone: �. D <br /> Time in: '1 Time Out: t ]P;agj <br /> EHD 16-24 (2m pg) 45113 FOOD PROGRAM OF CONTIN'' TION <br />