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""� SAN JOAQUIN COUIIf <br /> r. y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax."(209)464-0138 Web:www.s'gov.org/ehd <br /> LiRpR <br /> i <br /> M , <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: 4 city: Zip Code: <br /> Owner/Operat r: k7 Telephone: <br /> Program Element: Program Record: '� Inspection Type: <br /> il—W Posted Li)Ges No Permit Posted ❑ 11No Re-Inspection on or After: <br /> ,..,.�a �` "t � :.., <br /> L ak <br /> 'l ✓ <br /> '9 <br /> Cnv-KE <br /> h <br /> I <br /> l <br /> .t <br /> K <br /> d It 0�7r <br /> _ bu A�e 7L ° <br /> r'< Food.Safety Ceftitae a#ton r rl�ty h] t iillater Ts n � Sure:r ��'' 1Nare .,ast��ng�' e <br /> Name: Hand Sink: D� of Chlorine: ppm Heat: of <br /> Exp.Date. Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title:' <br /> EH Specialist: rVA Phone: <br /> Time in: ; ri Time Out: Pagerpt <br /> EHD 16-24 (2oO pg) 413x13 3 FOOD PROGRAM OIR CONTINUATION <br />