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�0�4 .coG SAN JOAQUIN COU�j � <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> � ..., �,.N�P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> ehd <br /> Lr�oa <br /> I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: rr/ Date: r <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: I <br /> Program Element: Program Record: Inspection Type: <br /> S8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> �eEIvlalA+t cc�RaEe�arcs <br /> xM.. ; r..... <br /> G� KE <br /> i <br /> I <br /> Itemi!i ocatrorTem3ierature liem J Locatian YTemperatre':: <br /> ® ., _ <br /> 7 <br /> m. <br /> IT food`.$afety Certification "' Facility fiot liilater Temperaittr t;,; 1Nar wa'st�ing ` P <br /> Name: // l2 Hand Sink: y of Chlorinepm Heat: F <br /> Exp.Date: arewashing Sink: �- 'F uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: �q71. Time Out: a iY� Pag& <br /> EHD 16-24 (2^d pg) 413113 ' FOOD PROGRAM OIR COONIT NUATION j <br /> i <br /> Ii <br />