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SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEt-ARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> t i i;o'Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` 41 f, jL l� L F Date: <br /> Address: -9--o , City: Zip Code: <br /> Owner/Operator: // � LL� Telephone: <br /> Program Element: PiWgram Record: Inspection Type: -,�/ / ,J <br /> e dig <br /> B180 Posted Yes ❑ Rermit Posted es 1i1 Re-Inspection on or After: / <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> vii- min <br /> tit In -- l <br /> 7mtor1v�4k� <br /> ,'4 <br /> L ' <br /> r = <br /> Name: / l Y� ��; Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: / arewashing Sink: of uat.Amm.: ppm Other: of <br /> vt'4` <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: D Time Out: I 12-0 Page <br /> =HD 16-24 (2^d pg) 4.13/13 FOOD PROGRAM OR CONTINUATION <br />