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SAN JOAQUIN COUNTY M <br /> ° ......... <br /> :a ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 4�IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �(rw Date: <br /> Address:, City: _ \ Zip Code: Get 5 <br /> Owner/Operator: Telephone: <br /> 10Z - Z t - ht!3 <br /> Program Element: ,�; ` Program Record: 1 1 , Inspection Type: <br /> S6180 Posted Fl Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS_ AND CORRECTIVE ACTIONS <br /> .�`�_ �— <br /> 4 <br /> cu'-j i - S P <br /> 2- <br /> C r� 2 i <br /> i <br /> ' <br /> z l - to l I -tzsl c� <br /> Name: Hand Sink: of Chlorine: ppm Heat: 7of <br /> Exp. Date: arewashing Sink: 'F Quat.Amm.: ppm ther: OF <br /> Re ivied By/Title: <br /> Own " <br /> EH Specialist: �� Phone: \ L, 11 , © <br /> Time in: 1 Z c Time Out: t .� Z Page Iof ' <br /> EHD 1624 (2"'pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />