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aRa"IN•. SAN JOAQUIN COUNTY <br /> 1; 'FPc <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sinov.org/ehd <br /> 4tlko"�N <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: `--tn A city:(-fAr. <br /> Zip Code: <br /> Owner/Operator: <br /> ��JJ Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> S AND CORRECTIVE ACTIO S. <br /> CDO1jjjAj <br /> �,21 <br /> o�-rx-Pi� <br /> S nr, Ph <br /> S <br /> U � <br /> 2 � <br /> e- <br /> O s <br /> fanWLoea o perature <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: Hand Sink: of ���washing <br /> m Heat: of <br /> Exp. Date: Warewashing Sink: =F 10 <br /> uat.Amm.: ppm Other: =F <br /> Received By/Title: <br /> EH Specialist: �) .J Phone: 2(:�>Oi_ LV( _ 3 25 <br /> ime in: Time Out: Pagggf2 <br /> EHD 16-24 (2° pg) 4/y1 FOOD PROGRAM OIR CONTINUATION <br />