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SAN .JOAQUIN COU( <br /> CoA- ........c <br /> .Z� 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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: __Po <br /> .01 4 Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: 64 a f rpt- Telephone: '�-/7? <br /> i <br /> Program Element: / Program Record: �p Inspection Type: 2—,)LI -h'x-e— <br /> SB180 Posted Aes No Permit Poste Yes No Re-Inspection on or After: 3w � <br /> QBSERVA'M-IONS ANQ CaDRRECTIVE ACTICiNS <br /> �� <br /> a _ r __4' c/_____6�•7 i-7 off- 1.4-b-e-- c�P• r( _._ -/o c.- <br /> I __ ��_ �i rr�L s ----��©� S.� w .-�d �5•.e ccs• e. b�-, c_w-e.p�1C <br /> Cct_.L1,1c'AeS _ lUv.rs <br /> 1.1.1.1._ ......._._....... _ - --. . .... ----- <br /> � Or� yh 7r�e r,e r r� f-7 GQ h© �- tZ U 44.X4 <br /> -I e I rods O f Bn _ _�f�r-�7_f7 cA -7j<- /zu G7 <br /> U aj 4 tal c--t 5 G 47eI <br /> e_S <br /> -h zle .bu e,fCc� f �'lU f 'Se f- -1 Xf ilc.0 r7 <br /> '" � teAtll t BtlCtt ex emA f tlfe ttetn ,L ocatlOn Tempe[atur@ <br /> a . . - 1,,111-��,,,•,v qa ...,4.._. �v... <br /> Illy er a rat <br /> Urea - 3reWaShing <br /> Name: Hand Sink: of Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist:• \ Phone: <br /> Time in: i Time Out: I/. Pageof <br /> 3 <br /> EHD 16-24 (2n°pg) 4/3113 f FOOD PROGRAM OR CONTINUATION <br />