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aur SAN JOAQUIN COU• Y <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 /> qtf PORN <br /> OD PROGRAM OFFICI L INSPECTION REPORT <br /> Name of Facility: Q {" Date: <br /> zn 10 <br /> ddress: Zip Code: <br /> Owner/Operator: vv n Telephone: <br /> r _ <br /> Program Element: rogram Record: C)L - Inspection Type:f <br /> SB f80 Posted 17 Yes El Reit Posted Yes ❑ I Re-Inspecti <br /> on <br /> C3BSER ATtr3 S rlN zri0ERr 11E'�fiTI ys „ <br /> t , <br /> is <br /> i+ <br /> S A, Cam <br /> / i! c <br /> 1. e <br /> ot- <br /> r 1 F <br /> o nY1 WL,.no <br /> T e ; <br /> h <br /> �S Es U iO fit. etc- 0 <br /> - v <br /> R s <br /> r <br /> S� rZQir' o p d <br /> r ec.vo—wq- S <br /> 1 7 <br /> � 4— <br /> i „ s' Tem eYatute= y"° tam lwocatron " fernperature <br /> r <br /> u- .: b _ s <br /> x z+iafety!Certiictaon ,. a11rty Tie Vitatei' empssratura ' 1Na€rew�aki�ng <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashjhg Sink: of Quat.Amm.: ppm Other: of <br /> Received By 1 Title: <br /> EH Specialist: Phone: �. <br /> ime in: Time Out: Page of r <br /> F I <br /> EHE 1624 (211 pg) 413113 FOOD PROGRAM 0!R CONTINUATION <br />