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�rAutn.. SAN JOAQUIN COUI,.; <br /> �4 A� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 aora/ehd <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web: — <br /> {crsdYi <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT I� <br /> Date: <br /> Name of Facility: dr S� Zip Code: <br /> oily: 2-0 <br /> FJUcb W k�fi�X <br /> ddress: _ Telephone: [�{ <br /> Owner/Operator: exAn /� .5�llh I <br /> n � + Inspection Type � <br /> : - <br /> V , <br /> Program Element: 1(� Program R cord: bo <br /> SS180 Posted Yes No <br /> Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CO .CCTIVE ACTIONS_,,,,... <br /> 11 v1a1a cufre <br /> .nod Safety Certification _ ;.- Warewasfi <br /> Name - Hand Sink: `F Chlorine: PPM (Heat: "F <br /> Exp.Date: 2ij� I(;1 Warewashing Sink: ,p 0uat. Amm.: PPM Other: 'F <br /> Received y/Ti : _1 <br /> EH Specialist: Phone: <br /> ime in: 112-,42 <br /> 2-. Time Out: 2=S Page f <br /> EHD 1624 (2n0 pg) 4PN13 FOOD PROGRAM OIR CONTINUATION <br />