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aBANIN•o SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />4..,, =•..;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: i <br />Date: _ _ 2S <br />ddress: i 5 1 S <br />d 2.a <br />city: Tro�c zip Code: S37 <br />Owner/Operator: <br />Telephone: <br />Program Element: \bZS Program Record: S, �p <br />6180 Posted Yes No Permit Posted Yes No <br />Inspection Type: <br />Re -Inspection on or After: <br />SANDE CTV C N <br />5 0.�1� .n <br />Jae . <br />S <br />` <br />C \r4p <br />a -,P- <br />'� -T1-e h <br />' •r -e �- �.. c o., -e <br />r\ <br />Item/Location, <br />mperature- <br />/tocati' <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />and Sink: <br />`F <br />Chlorine: ppm <br />Heat: `F <br />Exp. Date: <br />arewashing Sink: <br />'F <br />Mat. Amm.: ppm <br />Other: 'F <br />Received By/ Title: <br />EH Specialist• <br />Phone: 'L�p(_ k 3� 25 <br />Ime in: 1 r ZS <br />Time Out: \ 2 ` '7� rY1 Page -2-01 <br />EHD 1624 (2n° pg) 4/313 ' FOOD PROGRAM OIR CONTINUATION <br />