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, n",Z"' " SAN JOAQUIN CO UQ <br /> `y� <br /> ENVIRONMENTAL HEALTH .DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sipov.orglehd <br /> 0Ra <br /> .I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: % -� Date: 61 <br /> ddress: City: Zip Code: <br /> Owner/Operator: Telephone: / <br /> Program Element: Program Record. Inspection Typ <br /> 11<76S21 <br /> 8180 Posted [IYes [TNo Permit Posted ❑Yes ❑ No Re-Inspection or or After: i <br /> C3 ��fA"1'IIt�ISt at � f <br /> 'e.. ..,_. ._....� _.,�° _ <br /> .,.,__.............d_____^._...._...__.-.-.<:_.,_W_...,.._..W.„,..».... ...,........�_mn..�,n _....,,..»....,_.._.:. .......:.. Ryas i <br /> i <br /> L� � <br /> Y <br /> e sr3 i .�.w a �o <br /> i <br /> N <br /> tee . <br /> o <br /> �fi #,i! pr �xitr� :; fEt/ tin ,•. . empe>atrare <br /> I <br /> r neo®r1 skyert€aeatnic # ' 11 +I d� Frewashf .. . <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By!Title: <br /> EH Specialist: Phone: <br /> Time in: + Time Out: . r f^ Page of <br /> r J <br /> EHD 16-24 (2n°pg) 4!9!12 Y. a FOOD PROGRAM OIR CONTINUATION <br />