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i <br /> SAN JOAQUIN COUN j <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.. :�• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si,oq. v.org/ehd <br /> �+�oa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r rr/ Date: <br /> Address: City: Zip Code: <br /> ��. o 4, <br /> 0wner/Operator: / Telephone: y� <br /> r f r <br /> Program Element: Program Record: Inspection Type: <br /> 5BI80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> UAT1®4 �i4[+1O0RAJEC1IVE�AC�t3�1 <br /> w,.. <br /> C./ i <br /> I <br /> I <br /> a <br /> 1 <br /> i <br /> J <br /> i <br /> tion a-, s Tem, -mature 4 ,, <br /> _.< Item!l..oca <br /> i <br /> <voc>d Sal ty:Cer iIr tfait: :��4AI tea 1N terS 1 � r to rl It �a a"s.filing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of j <br /> Received By 1 Title: <br /> i <br /> EH Specialist: Phon <br /> I <br /> Time in: Time'Out:-,,, Page,of <br /> EHD 16-24 (2M pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />