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SAN JOAQUIN COUNTY <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.sigov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (,-r Date: Z <br /> Address: IR 09 or City: !->`� ` Zip Code: clS 2-v <br /> Owner/Operator: ll �-- i� Telephone: _�y�� <br /> Well I t Q <br /> Program Element: / Program Record: p •'7 <br /> � 0 '27 <br /> Inspection Type: � �� <br /> SB180 Posted es ❑ No Permit Posted 0 Yes '0 No ( Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> roan-. cmc r S2I -C/C7 O v t <br /> 2 <br /> OCX� r� -Prct✓cc�s2 i r�S ( CO✓yN � 1�+•-e � . <br /> CD c' C-cz- <br /> Name: Hand Sink: ' (D 0-L. of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: / ( of Quat.Amm.: ppm <br /> y Other: °F <br /> Received By/Title ,o <br /> EH Specialist: Phone: V G i �- <br /> Girr <br /> Time in: qTime Out: ry 1 v Page tofr <br /> V <br /> EHD 16-24(2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />