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SAN JOAQUIN COUNTY <br /> �o .cGG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q., ;�;;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s"gov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: �- <br /> Name of Facility: _ _ � F 1 3 2C <br /> Address: �`� City: Zip Code: G>C 52 <br /> Owner/Operator: _ \lp Y \ Telephone: <br /> 1 <br /> Program Element: Program Re rd: `(��,c�1 Inspection Type: <br /> SB180 Posted Yes ❑ No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> \ <br /> Ls —(U.2 QICN Ai�a t (A C�' T r\-,O s_� IAS E AA1 <br /> C <br /> Ae 1,421 <br /> rv-e <br /> fa•tiJ '-A to P <br /> '�AT` 1 ct t= <br /> nsCIL t <br /> Name:` �Hand Sink: -1_ `F Chlorine: ` ppm Heat: `F <br /> Exp.Date: rewashing Sink: 'F Quat.Amm.: ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: v .'2,Ao Time Out: V Page'2f <br /> i <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />