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SAN JOA[QUIN COU4'.) <br /> x. _y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siqov.oLg/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program ecord: Inspection Typ <br /> S13180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> M <br /> C l TT/ <br /> �. <br /> -A , <br /> - e �tliflaeashin � <br /> Fob>afirtcf{ tron _ ac�I WalAiatere ratui . <br /> Name: Hand Sink: of Chlorine: ppm heat: F <br /> t <br /> Exp.Date: Warewashing Sink�7� 'F Quat.Amm.: ppm they: oP <br /> Received By l T' �'f <br /> EH Specialist: Phon <br /> ime in: Time Out; - Page f <br /> EHD 16-24 (2^d pg) 41V13 FOOD PROGRAM 01R CONTINUATION <br />