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Y <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: — — <br /> Address: 2) V,5Cn City: _k Zip Code: <br /> Owner/Operator: <br /> +'� Telephone: <br /> Program Element: 1`—�� Program Record: `_ Inspection Type: Z <br /> SB180 Posted `V ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 _ <br /> � t-L�S2Q <br /> d LJ 3 <br /> 2 0 2 <br /> 1 <br /> C v.\ <br /> 2 ^rte --kOf 12 <br /> t 3q F \ C T-pk;,n 3b f'7 <br /> F 2- N 1 'A I <br /> 3 PAKs?_ 43 F 2Q v — C r <br /> -_t/Location mrw Temirature�� ite f ,.ocatiesrl <br /> �b = <br /> arewashing <br /> Name: ` 1Hand Sink: r ofChlorine: a ppm Heat: of <br /> Exp. Date: ` , _ :D �._ Z�-� arewashing Sink: \ � of Quat.Amm.: ppm Other: of <br /> Received By/Title: S; �} C'1 M f\\�7/"�' ��C-Ajf , <br /> EH Specialist: Phone: tib8 _03 ime in: Time Out: 2 Page <br /> EHD 1624(2^�pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br /> c�� <br />