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ot1A !".. <br /> SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: [t <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4t�FURN�P Telephone:(209) 468-3420 Fax:{209) 464-0138 Web:www.,slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> _S <br /> Address: s'r Date:3 cit <br /> b ,f Y r Zip Code: <br /> OwnerlDperator: `G Telephone: <br /> 1 htllr <br /> Program Element: Program Record: Inspection Type: <br /> SBI80 Posted Yes No Permit Posted Yes No �4e V 3 i 4 <br /> Re-Inspection on or After: <br /> L3I:i5EF lTA 1�lS ARA CORRT VE A4Tl�CD�I <br /> l <br /> -era nor 1'Gtf I 1 a1 1�. . <br /> d ir rn r <br /> f-Z <br /> Iti1Uletiori 1 aieratxtr 1ler1 Jt>Catic>r� Temperature <br /> actxi Baty Ceriacatio� Far[ Qt4faPermpatrare Warestli <br /> .... <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - — ---Phone: C�/! — <br /> Time in: Time Out: Page of <br /> EHD 16-24 (21 pg) 413113 FOOD PROGRAM OIH CONTi UATJON <br /> � S <br /> 05-5 S <br />