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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: a <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> l <br /> Address: t / City: Zip Code: <br /> Owner/Operator: �� 1 1' Telephone: <br /> Program Element: j L Progra Record: ctVll 4fyp9Inspection Te: <br /> VI , v <br /> b180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r v <br /> r? aC � t <br /> i <br /> ^ ; <br /> LZ <br /> s vj a C 1 ) W a�, ku aw'YG <br /> 10 /vulyC ✓+ nu'e� <br /> Wd V GCc 0 P4 vt <br /> G6 )✓mo o GC <br /> �. a r, tiQ <br /> ,{ h' lV <br /> n f k <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title. <br /> EH Specialist: Phone: C/ _�d�y S' <br /> — /� -- - <br /> ime in: 1 � -Time Out: Page of <br /> EHD 16-24 (2n°pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />