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SAN JOAQUIN COUN%..' <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c;,iFoal;a Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / �j/ - Date: <br /> Address: / - City: zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type• <br /> r <br /> B180 Posted 0 Yes 0 Rennit Posted 0 Yes 01 Re-Inspection on or After: <br /> 00 <br /> 3 <br /> ame: and Sink: "F hlorine: PPM eat: 'F <br /> Exp.Date: lWarewashing Sink: 'F r <br /> uat.Amm.: PPM er: 'F <br /> E <br /> d By/Titleciali P one: <br /> : /v Time Out: Q Pag�/o� <br /> EHD16-24(2-pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />