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r, Re� SAN JOAQUIN COUNTY <br /> � � ENVIRONMENTAL HEALTH DEPARTMENTCOO <br /> Q <br /> 600 E. Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd <br /> `°CIRC FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> y_Z3 -- <br /> Address: f City: Zip Code: ` <br /> Owner/Operator: Telephon <br /> Program Element Code: Program F415cord ID: u � h - Inspection Ty <br /> SB180 Posted C Yes C No Permit Posted C Yes D No Reinspection On or After: <br /> T :Q$ RIIA?[ ..S A1s1D D�EIRRE lllrvEO1VS <br /> La <br /> t <br /> !D1 Y14 <br /> CIJA <br /> d <br /> s <br /> Lx. <br /> V'QJG— - <br /> IF <br /> 1 <br /> i <br /> 8n � in. ,. � ItemLLocatiofi ' �*w._ f '� �,tftia fon <br /> m�.. _. _ <br /> i 3 czwZ 3 <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: r Warewashing Sink: °F Quat.Amm. ppm Other: ppm <br /> ENVIRONMENTAL HEALTH AND SERVICE CHARGE FEES ARE AUTHORIZED BY RESOLUTION OF THE SAN JOAQUIN COUNTY BOARD OF SUPERVISORS. <br /> L DOCUMENTED CRITICAL HEALTH VIOLATIONS OR REPEAT VIOLATIONS ARE SUBJECT TO A REINSPECTION AND REINSPECTION FEE. <br /> Received By: Title: --yt4 A <br /> EH Specialist: Phone: 394 <br /> Time in: n Time Out: d" f1 <br /> tJ Page: of <br /> Y <br /> EMD 16-23(2ND PG) FOOD PROGRAM OIR <br />'f <br />