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pegq!"...C" SAN JOAQUIN COUNT <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> y: :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slaov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i `: __I S`. Date: / <br /> Address: I �- �,� (4-7 City: Zip Code: <br /> Owner/Operator: s J' J /'I �' Telephone: 414- <br /> 4 1 ' <br /> Program Element: Program Record: U Z 2 C Inspection Type: <br /> L/ <br /> SB180 Posted Yes I_ No Permit Posted -- Yes No Re-Inspection on or After: <br /> Milk�4 j d'Et J2 <br /> ,,- ✓ r eGL! <br /> YG1� sl. <br /> vv vL ', 1�k'W tiff N u 1 u <br /> � rvv <br /> � Is ►may Z �... <br /> 6P 97 VV <br /> Al <br /> Name: Hand Sink: C)Q ' -F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: u o f Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: I Phone: <br /> Time in: Time Out: ) Page z <br /> f <br /> i <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />