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SAN JOAQUIN C4UR <br /> s.Q <br /> •.00 <br /> `X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . 4 _. ;�• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> L�Fa <br /> FOOD PROGRAM OFFICI L IN P CTION REPORT <br /> Name of Facility: Date: 27 <br /> ddress: City: �/� Zip Cade: <br /> Owner/Operator: Telephone: <br /> Program Element: Z Program Reco 2 0* Q Inspection Type: t <br /> 8180 Posted ❑Ye LiRermit Posted Q Yft ❑ I J Re-Inspection on or After: <br /> vs r V� <br /> - ' <br /> � 1 C <br /> 5 , <br /> r � <br /> r - <br /> r <br /> 1 <br /> r <br /> i <br /> J)A M4 <br /> CIA <br /> WoC_ <br /> ,._.,m..,...e.._. . �.�mE'. M q „".•"•a� m �r � .�$• 'TeEfYperatcil'e <br />� <br /> 2� 2 Ire <br /> Name: VJ4Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: Sarewashing Sink: of Quat.Amm.: ppm Other: <br /> Received By!Title: _ - ;6 , <br /> EH Specialist: Phone: g. a3E� <br /> Time in: Time Out: Pa9 f <br /> EHD 16-24 (214 P9) 413113 FOOD PROGRAM OIR CONTINUATION <br />