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SAN JOAQUIN COUI ' <br /> � •.OG <br /> y ?< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> q�/Fo.Ra <br /> �P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: <br /> Address: / <br /> 2) � City: Zip Code: <br /> Owner/Operator: 1 ` y Telephone: <br /> Program Element: /q. Program Record: Inspection Type: <br /> 8180 Posted Yes ❑ Rermit Posted es ❑f Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> n'U 4 <br /> 04 <br /> p�y� V►�tOc <br /> h /^ <br /> 1 <br /> 4/V l <br /> lx <br /> V V <br /> ,Temperature <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Ware hing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: Y` <br /> EH Specialist: !� Phone: (" <br /> Time in: I Time Out: Page f&, <br /> EHD 16-24 (2°1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />