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SAN JOAQUIN COUNTY � <br /> :a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-62 <br /> 32 <br /> �..- Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www-sigO�.Or /ehd <br /> q{;FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: <br /> [A',, <br /> me of Facility: <br /> dress: f�_,,- City: Z1pCode:Telephone:ner/Operator: <br /> Program Element: Program Record: Inspection Type: ����{ aej <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> w h ,;fl f oo"�J' �-rvu, art. <br /> `5 w i ► � � G <br /> /O r! !7 h/~ r► 4 <br /> GC d <br /> ~S ' d2Cv�avc� <br /> p t4Q r <br /> S L?Gt <br /> I)A <br /> L i� <br /> lWV" <br /> lad "mac b 14 <br /> 1�itB . " 7etlrpelrtt mora#o ititr ~ <br /> 3 1111 a ti <br /> �i!E.YIG�iL ..;_...• u..; �a ,aT � t zH- �1�5�.$i . <br /> Name: Hand Sink: of Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm Other: of <br /> Received By!Title: 5C <br /> €H Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHU 16-24 (2"'P9) 4/3113 F000 PROGRAM OR CONTINUATION <br />