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SAN JOAQUIN COUP;j <br /> ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> � ..,_ ,.�;;a• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.slgov.om/ehd t <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT" <br /> ,l <br /> Dame of Facility: Date: "may <br /> Address: City: Zip Code: € <br /> Owner/Operator: f // • /� Telephone: <br /> Program Element: Program Record: U Inspection Type.- <br /> SBI SO <br /> ype:SB160 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> � -„..,.»» .°a:�.: pper+ pp;;ii./ .;,yy ..:.�■r�^a. m.©e �: p;�,«x�:-ter .,. -^.�- a ..mss �-.,.-.�'� '�.. <br /> lk <br /> f, <br /> E <br /> 'e�/o <br /> ---—- --------------------. <br /> � I } <br /> @ �i1re %a EM �'�Grl7�t,.Oba�lon� •a” -^ � �E�l�fe���U.� r� <br /> d <br /> IN car HoVa„ermW .rature a. washing.: m . <br /> Name: Hand Sink: of Chlorine:. pm Heat: "F4 <br /> Exp.Date: arewashing Sink: ,";:Wo. aF Quat.Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist: <br /> ime in: - Time O t: r,J Pag t F; <br /> f <br /> EHD 1(x24 (2-pg) 4/3113 FOOD PROGRAM OR CONTINUADON <br /> f <br /> F <br />