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4 <br /> SAN JOAQUIN COUKJ <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT ' <br /> _ 1868 East Hazelton Avenue, Stockton, CA 96205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)4640138 Web:www.si4ov.ortllehd <br /> I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 Date: <br /> Address: Loi r City: Zip Cade: <br /> Telephone: <br /> Owner/Operator: <br /> � <br /> Program Element: L �S Program Record: $�2 ZG O Inspection Type: <br /> ie a 'r2 <br /> B180 Posted IKYes ❑ No Permit PostedAYes ❑No Re-Inspection on or After: <br /> y �I� #A3N ► liR STI Al f1 ... .... � <br /> y .. <br /> ."Sim _ <br /> N� n IGOr p.vc cL .. � <br /> • <br /> Alb (W-CID ,E. <br /> 6 <br /> vrI'eG� fps <br /> w <br /> r C/ ` <br /> -- <br /> -rct1Z 5 - 0 <br /> WcVkM e�( 36oAll <br /> w <br /> v U S -- f7 <br /> ttern/Ipaattorr . Ea'rnatus �leaai€` otfcrc 7i%srafurteirrioci> .. .. Certapertur <br /> d r 77"-f Lt a <br /> r si� D p 4' <br /> U /rro 7- <br /> i~orttratp; 4:-: aai # StiV4tsaI a " ; __ 1ftelaiasl± gq ' <br /> Name: - Hand Sink: �°F C lorine:, /00 ppm <br /> . Heat: of <br /> Exp.Date: 3 arewashing Si `F Ouat.Amm.: ppm they: 'F <br /> i <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: 60 Time Out: Page of <br /> I <br /> EHD 16-24 {2'llpg} 419112 FOOD PROGRAM OIR CONTINUATION <br />