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> i4 coG , SAN .1QAQUIN COU1�►� <br /> Z� ENVIRONMENTAL. HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205.6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: I L 42 <br /> ALJ city: O Zip Code: D <br /> 1 �►(. <br /> OwnerlOperator: Telephone: <br /> O 4�. <br /> Program Element: 2 PrograffRecord: 0 Inspection Type: <br /> L82posted L ©Yes ❑ Rermit Posted D Yes ❑1 Re-Inspection on or After: <br /> toy ONS ND-06OfN 0 V ACI MNS <br /> P <br /> ---- <br /> 1 C) <br /> r <br /> - -- <br /> A CO r- <br /> - � <br /> - - t <br /> L � � <br /> S 5 ' <br /> s U T_- -- � <br /> « 0� <br /> -- �t- <br /> - it f _._ <br /> "k -a <br /> t ~ ' n n25 <br /> re Q r r <br /> SS-- -- <br /> ,ratan=_ ; t f soca on TecnperaWre <br /> Name: Hand Sink: 0 "F hlorine: ppm Heat: -F <br /> Exp.Date: arewashing Sink: i►1 of uat.Amm.: ppmOther: of <br /> Receive y 4e- C'jqk Opt <br /> � V <br /> EH Specialist: Phone: r 0 <br /> time in: r Time Out: z© Page of <br /> EHD 16-24 (2nO pg) 413113 FOOD PROGRAM OIR CONTINl1ATION <br />