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SAN JOAQUIN COUN <br /> i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .�4'• a :� Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.s4gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code <br /> caner/Operator: A TeleP ho 3 <br /> Program Element:' 3 Program cord:��0�6/ '� Inspection T pe: <br /> B180 Posted d Yes ❑ No Permit Posted ❑Yes 0 No Re-Inspection on or After: <br /> •e ._....a,. ... ...... .,......... .:.. n.....,., . . a,.�, •-. ..... ,. . . max,. <br /> Zen ."— <br /> �.m. �­ :..... <br /> >. 3 IternlLoc on =Tart l d1#a t i? :rP +ott: erf per t re <br /> r3ttiffcair° crtgr 1at+srrttperlr . reii�asti <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: PPm Other: of <br /> Received By/Title: <br /> EH Specialist: Phon ,, <br /> ime in: f O Time Out: '12:57 <br /> EHD 16-24 (2nd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> k <br />