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SAN JOAQUIN COUW,. <br /> b 'y{ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 3 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0938 Web:www.sjgov.org/ehd <br /> �lPUfi <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'S Date: A_ <br /> Address: '2u(]�7 City: Zip Code: <br /> Owner/Operator: Telephone: Tp l <br /> Program Element: Program Record. Ss a Inspection Type: V <br /> SBt84 Posted 0 Yes ❑ Rermit Posted ❑Yes F"I Re-Inspection on or After: <br /> 7E A "� l�tj31 1 5,CT1'I I�AC' ' <br /> 1`'I <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: _ ppm Other: "F <br /> Received By!Title: <br /> EH Specialist: `'? � " l Phone: ��r ,^ti — <br /> Time in: + r Time Out: 760 Page of <br /> EHD 16-24 (2"Ipg) 4!3!13 1 FOOD PROGRAM OIR CONTINUATION <br />