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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> E 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4�;FoaNF Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s4gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> =YesNo(' <br /> Date: _I <br /> r W <br /> 56 LA-) I � tko Lf- City: 5 L_ �n zip code: <br /> TU <br /> �W t 5 -�- Telephone: _)7t: 1 ZtP Program Record: b t L.e b g 4 Inspection Type: <br /> xt?cl (Zi lYes No Permit Posted Yes No Re-Inspection on or After:La�c Me <br /> M <br /> I Y 6i "V-PQ r U' C;00(#-✓ &s 54-i I I n o <br /> )I <br /> A ^ n o-F <br /> LIS¢ C Fa0 r U e4i I &, r t cl t'a-i lot <br /> '2--) <br /> two ru uJ.�+ Q_ <br /> rt c y- Z"-6x 4' le <br /> rvu' <br /> Adl <br /> I-e r vi-t-r <br /> Temperature ftem/Location <br /> arae: Hand Sink: of hlorine: PPM t: of <br /> xp.Date: arewash g Sink: of uat.Amm.: PPM r: ,F <br /> eceived By/Title: n <br /> EH Specialist: -' <br /> pecialist: - Phone: <br /> ime in: <br /> 4-2 Time Out: 1 to•'L Pa 91 <br /> of I <br /> EHD 1624 (2-Pg) 4/3'13 FOOD PROGRAM OIR CONTINUATION <br />