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SAN JOAQUIN COUP <br /> ).•'oyEFl4'•.O <br /> W X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. = iP• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> L�FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: i City: r c. Zip Code: Q S I G <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> AQIM <br /> pBSRA�C3N5�NDflRRECTIUTA�'t IClN.. <br /> 2 n <br /> ' cc /v W 1,,,^ S h . ift v" <br /> s k G i o s i r, el <br /> Q'i �r <br /> Was hCil /hcln W(-.1 l cc-cC' hA <br /> ) S K ccice � ; evl .) 41I <br /> a • � <br /> e r; C r�, �Gr c� '� Pr ^/�L <br /> •) (J C'Y i i P <a c r"1 Lf J <br /> _ �1 <br /> P 1)61r re lc, ( .[ ' ' <br /> s L7C, E ^ i I S 4, 1 r, <br /> eq <br /> )1S L <br /> R1, lec, k <br /> n 11S <br /> Lk) C11 -; S' 'fcre Ve r, JH G ,nV L/ c� <br /> � UUc� 1 S 4&re r4 w e Un CLLJ': r <br /> r� r c, d - /c - c4 l fo �S n rc " A, C "e►^/01[ <br /> f\VJin . le SSG /ed 'b,! u)een Gt / '�f 'n d 42 ro a lc, �j /- <br /> .2-doar 41 'e 7—ro e (' Lit.) <br /> . w _ <br /> Name: Hand Sink: / ,- i ..F of Chlor iine: ,2G1�l ppm Heat: C i o f <br /> + ) L-Mll <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: Ppm Other: aF <br /> r <br /> Received By/Title: <br /> EH Specialist: _ Phone: <br /> Time in: / Time Out: v C Page,of <br /> EHD 16-24 (21'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />