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oP�'�"` c SAN JOAQUIN COON <br /> ot= <br /> p ENVIRONMENTAL HEALTH DEPARTMENT <br /> W: . :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 'telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> Lroll- <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: `, y�7 GP City: Zip Code: <br /> Owner/Operator: 7Telephone: <br /> Program Element: Program Record: O l Inspection Type: <br /> B1 SQ Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> __ .,....b_- .dam.... .... ...... ....... ......._. .. ......_ .... - <br /> 1 <br /> - Ute' �.' i�� • <br /> F <br /> I <br /> fterar�' ocatuin; ... g ;;Tatnra; /fr ocattnn Temperature'; <br /> k <br /> ,y m <br /> . :,�� 1=ood Safe Certificaitrvna e Far.�i��i,}fot3161at�!''�ernperre. � ,°® _- YiTarashing'. ., <br /> Name: Hand Sink: of Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> 14 <br /> Received By/Title <br /> EH Specialist: 1-hon .q <br /> ime in: Time Out: L� Pac%" .1 <br />'y EHC 16-24 (2^'pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />