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a�4"'"• c SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95295-6232 <br /> �Rtlkiia�� Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:wwwsiQoy.oralehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ ,r r Date: 777 <br /> Address: O t Zip Code: <br /> Owner/Operator: ✓ - Telephone: <br /> Program Element: f Program Record: 0 Inspection Type: <br /> SS180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> ..........:. <br /> _,:° � ...... m �....., . .'; �.` ° a, OBSERil�1'T1aN�1•!N�']�ORRE�TIV�`A�T1�NS , <br /> � L • �` � � Wiz' <br /> I <br /> i <br /> c Or <br /> a <br /> I <br /> I <br /> I <br /> I <br /> iuc_ lors <br /> i <br /> :. <br /> Food:Safety C�rt�fica#iort F �c1� HCi 'V�lAteC �n# TalIrE Warewasmgalmnj <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp.Date: Narewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received <br /> EH Specelist: Pho <br /> ime in: ,. Time Out:a • Pa '"f <br /> EHD 16-24 (21'pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> I <br />