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SAN JOAQUIN COUNTY <br /> �+ ENVIRONMENTS PARTMENT <br /> N: X <br /> 1868 East Haze on Avenue, Stockton, 95205-6232 <br /> • �;.. - iP• Telephone: (209) 468-3 20 Fax: (209)464-0138 We www.sigov.orq/ehd <br /> FOOD PROGRAM OFF CT <br /> ION REPORT <br /> Name of Facility: Dater/ <br /> Address: City: Zip Code: � 30 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> i <br /> SBI 80 Posted n Yes ❑ No Permit Posted ❑Yes ❑No Re-Inspection on or After: <br /> .- _.y _ ..::.- •.. :.., q'.acs :-.:.�, <br /> OBSERVATIONS. AND CORREC r IVE ACTIONS <br /> �i <br /> ' p. <br /> Name: Hand Sink: / of Chlorine: ppm Heat: of <br /> �G�i�G�yP � /' �'i <br /> Exp.Date: arewashing Sink:��� of Quat.Amm.: ppm they: of <br /> Received By/Title: <br /> v <br /> EH Specialist: Phone: <br /> Time in: Time Out: /5 Pa g of <br /> EHD 16-24(2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />