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aP4u'•"• SAN JOAQUIN COUNTY <br /> ys ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.- ca Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sioov.orD/ehd <br /> 44jFb.�p <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> ame of Facility: Phev a i;[ I-6 '— Date: <br /> ddress: h M4 <br /> w,I^`I— City: Zip Code: <br /> bac a )•e <br /> wner/Operator: ► f Telephone: <br /> c <br /> Program Element: ( ��/_ Program Record: P/z D//_ p /Z Inspection Type:r{ <br /> B1 BO Posted Yes No tP Permit Posted Yes No U' Re-Inspection on or After: <br /> IONS CTIONS <br /> O re In qu elzwr 2. 'L 9-02-2 1- vu <br /> ah <br /> �L�{'i l m✓ n� SI ( r►2J <br /> ,tee 1 <br /> r 1. ik CX v <br /> ]'Temperature <br /> IP ' <br /> _ Food Safety Certification Facility Hot Water Temperature _ Warew <br /> Name: Hand Sink: eF Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of rust Amm.: PPM ther: of <br /> Received By/Title: <br /> EH Specialist: ./1n. �",� Phone: u L/ <br /> ime in: : 3 I ►vim Time Out: ` Page of <br /> EHD 16-24 (24 pg) 41313 FOOD PROGRAM OIR CONTINUATION <br />