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?a qu I IV-.cQG SAN JOAQUIN COUN- <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjqov.o[g/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of f=acility: Date: <br /> Address: City: Zip Code: <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 /> t]BSEFtV]4tld 1FFEC11/E i7taS�� � «: <br /> ._ . <br /> --- <br /> y <br /> «�> €.:�� fi,>�117/1.oC:i' � :x.. :� ratw'e °� m�Locaiib�rA< ,. lure. i <br /> I <br /> r <br /> f <br /> 101 ssti' a� ft1 q7t. C�r tlotilftatrt em rare eHrastnn <br /> 4 <br /> Name: -° Mand Sink: oP Chlorine: pp��LHeat: F <br /> Exp.Date: arewashing Sink: oP Quat.Amm.: ppm aP <br /> Received By/T' e: <br /> EH Speci Phone: <br /> Time in Time Out: Pa9 t I <br /> I <br /> EHD 1&24 (2nQ pg) 4rN13 FOOD PROGRAM OR CONTINUATION <br /> i <br />