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oPa"'" • SAN JOAQUIN COUO <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.c.., ;i• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> 4�IFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddress: WQ S ✓v L _ City: / ' Zip Code: <br /> Owner/Operator: +�_ l- Telephone: <br /> Program Element: Program Record: Z,( >1 Inspection Type: <br /> SB180 PosteB as ❑ No Permit Posted Yes No 11 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> LvFf� C_ zt <br /> d <br /> G- O` <br /> 72-7F 1 <br /> 0 w� vtcK <br /> l <br /> YYi <br /> Name: 14andF hlorine: PPM Heat: 'F <br /> Exp. Date: arewashing Sink: /1 eF uat.Amm.: PPM ther: DF <br /> Received By/Title: (/ <br /> EH Specialist: 13 <br /> Phone: <br /> Time in: Time Out: Paget/ <br /> b //�� <br /> EHD 16-24 (2n°pg) 4/9/12 �, FOOD PROGRAM OIR CONTINUATION <br />