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SAN JOAQUIN COUNTY <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q..- -"�;;p• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.segov.org/ehd <br /> �/FOfR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t/lJpl �y S Date: S-A -l V <br /> n <br /> Address: City: Zip Code: 955 7.6 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: p <br /> SB180 Posted ❑Yes ❑ No Permit Posted F] Yes Ci No Re-Inspection on or After: <br /> BSERVATIONS AND CORRECTIVE,ACTIONS <br /> ,,I r✓I <br /> 2 -" <br /> Name: f Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: awing Sink: )2 6 of Quat.Amm.: ppm Other: of <br /> ti <br /> Received By/Title: <br /> L_z_ <br /> J <br /> EH Specialist: Phone: 6 ir <br /> Time in: . Time Out: , 4 a Page of <br /> EHD 16-24(20'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />