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Q"'" SAN JOAQUIN COUN' <br /> y-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • •.. ;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> 4�%FO'itll <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: / Sj <br /> Address: ��r� City: �, Zip Code: S� <br /> Owner/Operator: / Telephoner -57 F <br /> Program Element: y -Program Record: ���Sa���a Inspection Type: <br /> SB180 Posted Yes 1 No Permit Posted Yes No Re-Inspection on or After: <br /> m <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � F <br /> tz <br /> 5 � <br /> ..�,. ., ,.. _; __ .,,,. .,, • , . 3_x-, .�. ,. _tet �. ..„... -F- .r - <br /> �Y <br /> LChlorine: <br /> Name: Hand Sink: of ppmHeat: of <br /> Exp.Date: arewashing Sink: oft.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH S ecialis,. Phone: <br /> paq 1: <br /> Time in: Time Out: / QS Page,of <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />