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SAN JOAQUIN.COUNTY <br /> .z� ENVIRONMENTAL HEALTH 1 DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(249) 466-3420 Fax:(209) 464-0138 Web:www.sipov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION2 REPORT <br /> Name of Facility: 77- Date: 15 <br /> —Z1- t <br /> Address`s 1 1 City: Zip Code:cll5� <br /> 0wner/Operator: Telephone: <br /> Program Element,,. �2 bq5 Program Record: 2_77Z 30 Inspection Type: <br /> %01SB180 Posted Yes No Permit Posted Yes No. Re-InspectLO ion on or After: <br /> 5w C385A1fA �0A#5 ANi3 Ci)RREGTiV ACS tQMS.: . <br /> __ .. ..._._ ..: a . <br /> 2 <br /> G �V <br /> ` tsll <br /> TIL <br /> L <br /> ICE <br /> ILA 2 <br /> S C <br /> J <br /> x01 <br /> 1 ood;Safety C rttf�cation r r Facai�ty Hnt Wa#er.Temperature _W& hip <br /> Name: Hand Sink: of Chlorine: ppm Neat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: r ice) Phone: l ' `�, <br /> Time in: C� Time Out: .� �E1 Page, af3 <br /> END 16-24 (21d pg) 40.13 FOOD PROGRAM ON CONTINUATION <br />