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P°"'" SAN JOAQUIN COON <br /> Q` .yam ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> 5 iF <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r v Date: ,G. j <br /> Address: City: Zip Code: <br /> Owner/Operator. f Telephone: <br /> Program Element: TLoff5 Program ecord: Inspection Type: <br /> S13180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> r <br /> w a h W l a -t e <br /> v h I i VU Indj2 vy, tm I Ini rn U vi, -"tl C� <br /> ush — P rn <br /> v w MSh i - <br /> 5Ah t A± 10 b rn rYt 1Y11{-v►�1m �e <br /> rn,not <br /> Val &t I -I t V-- <br /> ev 440 W- ton KA <br /> Item/Location - Temperature <br /> p �_ Item 1 Location Temperature <br /> I <br /> Food Safety Certification Facility Hot water Temperature i warewashing <br /> Name: '!Hand Sink: F Chlorine: ppm !Heat: �F <br /> Exp.Date: �arewashing Sink: of Ouat.Amm.: ppm Other: -F <br /> Received By/Tit <br /> r <br /> EH Specialist: TA 6" Phone: <br /> ime in: /1 IM Time Out: r ` a- Pag of <br /> EHD 16-24 (2nd pg) 413113 �(/�► l `tJ FOOD PROGRAM OIR CONTINUATION <br />