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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.• :P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �7F0!t ff <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , �L _ - L Date: <br /> Address: �- City:i/- Zip Code: <br /> Owner/Operator: Telephone: <br /> n <br /> Program Element: Program Record: co Inspection Type <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes/❑ 1 Re-Inspection on or After: <br /> QB$� <br /> qv, TIONSAND CORRECTIVE ACTIONS <br /> e-, /Q7 <br /> '` ocafit <br /> Aot 11Vit&Temoviturff <br /> Name: Hand Sink: _ of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: ,� <br /> g-- 4 /�- <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24(2'1 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />