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OS•au•'.. �` <br /> SAN .JOAQUIN COUI�i <br /> z: ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .•cq �� Telephone: (209) 468-3420 Fax: (209) 464-0138 Web.www.sjcjov.oM/ehd <br /> lehd <br /> {lFOR <br /> FOODPROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: —r Date: — <br /> Address: <br /> City: Zip Code: <br /> wnerlOperator: Telephone: b-2 "_0 <br /> Program Element: Program Record: S-2---7 2 Inspection Type: 'Q. <br /> 1 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> B180 i# 2 LZ <br /> ISI >. <br /> r <br /> C>' <br /> S t <br /> I ' <br /> Ppd$afly; eltft�tl :• f` ti1 € tta � f a .< 4tiri#washlrig, ` <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist �1_ Phone: <br /> Time in: � 1� V 1 Time Out: 1171 �V Pagel pf <br /> EHD 16-24 (god pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />