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" r SAN JOAQUIN CO -Y <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 96205-6232 <br /> . e... ;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slgov.org/ehd <br /> 'QLj FORK <br /> FOOD PROGRAM OFFICIAL INSPECTION DEPORT <br /> Name of Facility- Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: // Program Record: 1D O Inspection Type: <br /> SBI 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> C8C3$EE1VAj1_NSA <br /> ND:�� E AC 1JNS <br /> i c j ci_ _e Y- a. - r ��P d r h.e s 4_11 (>E. hatA ea.-e b <br /> itemltocatitaln - mper�f 1# rrt t lir rs E Tem er ure. <br /> i <br /> Food Safety,C-poi ication it Faci)f, tio#ilVater Tem.giraturq111iarewashing — <br /> Name: Mand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: mm Warewashing Sink: 'F Quat.Amm.: ppm Other: o f <br /> Received By!Title: <br /> !=H Specialist: Phone: �L <br /> Time in: Time Out: `7i ! i 5 Page of I <br /> EFfD 16-24 12^ pg; 4,'3/13 �i FOOD PROGRAM OR CONTINUATION <br />