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i <br /> SAN JOAOUIN COUI <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ��1r a N` .. Telephone:(209)468-3420 Fax:{209) 464-0138 Web:vrww.s' ov.or lehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Dater <br /> ddress: City: Zip Code: <br /> Owner/Operator. Telephone: • f <br /> l uc <br /> Program Element: J Q Program Record: t C Inspection Type: <br /> B180 Poste Yes ❑ No Permit Posted ❑Yes o Re-Inspection on or After: <br /> tea. . .- <br /> e. <br /> I vi a_ h Ll(.A, c vt- <br /> aVq JA_ <br /> vn <br /> i <br /> OIL" lax xa <br /> v'f <br /> GLw�I p � vu <br /> w.. .......... <br /> � ,-e:e � nanif» � :��, '�� �ie .,.�. n :' �' � `..:..�Ec1�►t,�ara�.�o. � �`�!r� 'atur�:_ :.�. �t �!Gnt�€ • . .�!�i� �'e <br /> a <br /> Name: i Hand Sink: i _31 -F Chlorine: ppm Ether: <br /> eat: 'F <br /> Exp.Date: arewashing Sink: liq of Quat.Amm.: ppm of <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> z. <br /> Time in: ( Time Out: Page??v <br /> EHD 16-24 {2nd pg} 419112 FOOD PROGRAM OR CONTINUATION <br />