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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> 9��POR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �'� k I t6 (y h4�'/ <br /> Date: I <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: /L Inspection Type e)` <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No '7 Re-Inspection on or After: <br /> O 3SERVATIO14S AND CORRECTIVE ACTIONS <br /> 41"j i1v h '1 <br /> J2 <br /> ytAL- <br /> Name: ��p� Hand Sink: -F Chlorine: ppm Heat: `F <br /> Exp.Date: ,,,L/L a . arewashing Sink: l n 1, aF Quat.Amm.: ppm Other: aF <br /> Received By/Title: lY M <br /> EH Specialist: /,1 Phone: <br /> Time in: Time Out: Pagerf <br /> EHD 16-24 (2M pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />