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Qea"I" SAN JOAQUIN COUN � <br /> k. •..oma.. m <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> �: . X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> gid. �P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.smqov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: f <br /> City Zip Code: <br /> Address: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B180 Posted es 0 No Permit Posted as ❑ No Re-Inspection on or After: <br /> I <br /> d <br /> tteml3x�catilb[t ..... { em t;«ro1 k `['effiperature <br /> ,foo �t C.4 ertkfca�on a 31 Pitt#tAfater T r tt$; ;.:,,; [�Varewash�ng <br /> Name: �? Hand Sink: j of Chlorine: Ppm Heat: of <br /> Exp.Date: � arewashing Sink: `F uat.Amm.: PPM Other: °F <br /> Received By I Title ,� <br /> i <br /> EH Specia st: Phon j <br /> ime in: �i�` Time Out: a. Pa of r <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM 0IR CONTINUATION <br />