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y i <br /> QufH SAN JOAQUIN COON <br /> 4` ENVIRONMENTAL HEALTH DEPARTMENT <br /> ar . X <br /> 1 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c� �,;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sfgov.org/ehd <br /> ZfppA <br /> FOOD PROGRAM OFFICIAL INSPECTION DEPORT <br /> Name of Facility: Date: <br /> Address: l City- Zip <br /> Code: <br /> Owner/Operator: Telephone: <br /> l <br /> Program Element: / Program Record: Inspection?ype: <br /> 5B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> Pah..». ':. -•-gym ...r,,^ ^�-i.. -v°r:•• §^-^� v.sa5tz s.® c .:y, +s'.Y&.-. `= ^, <br /> -- _ ..-.-._-.-...._........._ <br /> - — -------_ _ -_--- ---- _ -.-�f1 ------------ <br /> - ----Ate _-. <br /> Urn <br /> 4 T � <br /> .;..-- ,.x..m... �; +4> -s3' a ^.—, �,.w.;:. <br /> _ i peratslre <br /> �e ocaLa rr ` rate fern t ocat�on �Y <br /> <. <br /> oEiGl' yi trtox, NEW,acts o Ater' perett a= ,. �tnrashing <br /> re w , <br /> Name: � Hand Sank: of Chlorine. ppm Lat: np <br /> Exp.Date:3 arewashing Sink: of uat.Amm.: ppm of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ,� Time Out: /v Pag of <br /> EHD 16-24 (2nd pg)413113 FOOD PROGRAM OR CONTINUAPON <br />