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oPau�N. SAN JOAQUIN COUN%d <br /> ?{ ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s o'v.or lehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> r Date: �� I S- I <br /> Name of Facility: <br /> City: Zip Code: <br /> ddress: Telephone: <br /> Owner/Operator:Aerator: <br /> Program Record: Inspection Type: <br /> Program Element: Z g 3 0Z <br /> B180 Posted C]Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: 2 <br /> i .A c�n9-4 <br /> c � <br /> v QA <br /> ES 1 c! - <br /> 1� Q �_ � <br /> ----- _ _ --............-..... <br /> --- ---------__ _ <br /> Name: Hand Sink: `F hlorine: ppm Heat: "F <br /> Exp.Date: Warewashing Sink: "F uat.Amm.: ppm Other: 'F <br /> Received By!Title: <br /> Eli Specialist: � _ Phone: <br /> ime'in: W Time Out: 1`. Z Page of <br /> EHD 16-24 (2i°pg) 413113 FOOD PROGRAM OR CONTINJATION <br />