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,.....°"�." SAN JOAQUIN COUR <br /> .:..� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 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: �f C, Date: <br /> Address: &J V� city: Zip Code: <br /> Owner/Operator: C S _�. ` Telephone: <br /> Program Element: �� Program Record: �• Inspection Type: <br /> J ( C�' £ C L <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-inspection on of After: <br /> X <br /> OBSERVATIONS AND CORRECTW.�,.. N5 <br /> ✓11 �, �- Oti t vt �t CL's 1 <br /> I <br /> Name: Hand Sink. of Chlorine: ppm Heat: of <br /> Exp.Date:' arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title`. <br /> EH Specialist: Phone: / c/ �/ <br /> Time in: Time Out: l} Page of <br /> � <br /> EHD 16-24 (2°d pg) 4'3/13 FOOD PROGRAM OIR CONTINUATION <br />