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SAN JOAOUIN COUK,.� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sicl0v.org/ehd <br /> 4�ikaRr' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Date: <br /> Address: City: Zip Code: a <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> . � <br /> OBSER A,'�1£)NS ,t+l© ARRECTl1/E,ACMONS ', y <br /> w �_�- = <br /> - CSC - -_- -- <br /> G i _J-- - - <br /> �irr - <br /> - <br /> - <br /> :. -<-......_ _ ruse- . - �:�>:...,..,.>..,��*�.,>,.� •- ern ratnre� _ _ <br /> Food_5a#$ rfiCtaoi: =;�:� y �cil `:t3o 1N`!e`: em rater - ;� <br /> r <br /> i a c-$ a- ilfiarewashing ; <br /> Name: Hand Sink: F Chlorine; ppm Neat: F <br /> r <br /> Exp.Date: ar washing Sink: °F Ouat.Amm.: ppm then. of <br /> Received By 1 Title: Or <br /> EH Specialist: Phone: <br /> Time in: f 7fime Out: Page of <br /> EHD 1fr24 (2^ pg) 41313 FOOD PROGRAM OIFl CONTINUATION <br />