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°"sulk SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenge, Stockton, CA 95205-6232 <br /> �'L�; o a p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjqov.o[g/ehd <br /> 52 FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Address: Date: / <br /> City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> ISB ISO Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> 4BSERVA7"IaNSANU3 CORRECTIVE. GTla11iF5. <br /> �f� � �i»irrr�r�• ��� l� a <br /> #t$r► E oc�2�an _. <br /> ... <br /> av7em [aforei i acatian" 'T at <br /> uati'SafetyG¢rt� eatlonacilitygtlVaterTeratue1Narewashing <br /> m .,. <br /> Name: Hand Sink: ofChlorine: Ppm beat: of <br /> Exp.Date: Warewashing Sink: aF Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Spec'i 1st:_ Phonr3!� ) <br /> ime in: _--- Time Out:—� Pag of <br /> EHD 16-24(2nQ pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />