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SAN JOAQUIN CC TY <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 /> �%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; u .' Date:. <br /> Address: ' �Y� r City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: I j, Program Record: U S 1 t% S Inspection Type:IS <br /> 6180 Posted r•[ Yes ❑ Rermit Posted l Yes Li I Re-Inspection on or After: mit <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ✓vim,,, ,� ".e . <br /> V�k <br /> now <br /> Name: Hand Sink: U of Chlorine: ppm =Heat:Exp.Date: arewashing Si k: ofQuat.Amm.: ppm <br /> Received By!Title (4 <br /> EH Specialist: ' Phone: ( r <br /> Time in: Time Out: Page—of <br /> J <br /> EHD 16-24 (2ntl pg) 4,'3113 FOOD PROGRAM OIR CONTINUATION <br />