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Y:r ,. Jrs"1 ► r1vi I. <br /> SAN JOAQUIN COUNJ ! � <br /> q y� ENVIRONMENTAL HEALTH DEPARTMENT b <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 r <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/�liLhd Ik <br /> ��/FORM 4 <br /> I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORTI� <br /> ;, <br /> [ame of Facility: Date: <br /> dress: Z City: O Zip Code: <br /> nerlOperator: �Cj A Q u 0 � Telephone: ' yQ "Sogram Element: r Program Record Inspection Type: OG <br /> 818D Posted n Yes ❑ Rermit Posted E..- ❑Yes ❑ I Re-Inspection on or After: IR <br /> g <br /> ATICT9 <br /> n <br /> ne) U� $ k I-(-- <br /> M <br /> II <br /> II <br /> d <br /> it <br /> LkA <br /> I <br />. II <br /> t ® 'f- <br /> ,I <br /> L) M44 CC <br /> k6 tA 1100 J 771Z JA � e <br /> or r_-&V r_-&Vt <br /> ................._,..._...._._....._.,........................_....rt,...rt <br /> .ttda mtea ft' _ �;Jrattu <br /> �. e..r.�.... <br /> Name: 5... Hand Sink: ` 'F Chlorine: ppm Heat: IF <br /> Exp.Date: l arewashing Sink: l uat.Amm.: they: iF eF PPm ¢ <br /> Received By!Title. �, q E ` .I1 <br /> EH Specialist: _f Phone:- <br /> Time <br /> hone:ime in: r.' Time Out: Page of <br /> EHE 16-24 (2'd pg) 413113 V FOOD PROGRAM OIR CONTINUATION <br />