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p <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • •C4��POR�`P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.segov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _� - — <br /> Address: '1 1 �}� City: Zip Code: s�7 <br /> Owner/Operator: <br /> Program Element: 5 Program Record: Inspection ype: V <br /> 77 E <br /> SB180 Posted Yes ❑ No Permit Posted ❑Yes Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE.ACTtONS <br /> 1 OD Tait 1�bei — s_-c i o <br /> AD cLa+yjS7n /-IAv a p i S - ►i l� <br /> ap <br /> (E—) 4JAit JtJAIRV�_ AJ I £� G(1 J <br /> 00 Ad c BIZ c 0 Y)rs Z <br /> K L_ O D /ilJ uJ — <br /> M4. — Al Al N-j-Vh c� ).►14,,,„ a t <br /> a Z a LrcrL 6 I� <br /> Name: _Sink. t o y o o f Chlorine: ppm Heat: o f <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: le, <br /> EH Specialist: Phone: <br /> Time in: Time Out: ! Page of <br /> EHD 16-24 (2^'pg) 413113 FOOD PROGRAM OR CONTINUATION <br />