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SAN JOAQUIN COUf� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c..• ; Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sagov.org/ehd_ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: > Date:-3/1 1 ' <br /> Address: 5Zz { City: ��{-��r.tr-rE�l-1 Zip Code: G� <br /> Owner/Operator: 1 hO�1 � u �5� �1 v `i�" TelephonegI6_ 1-1-+_10161 <br /> Program Element: �JU` Program Record: V�; G�-� ` Inspection Type:'P x e cAi QT) <br /> BI80 Posted ❑Yes ❑ Rermit Posted d Yes GI Re-Inspection on or After: `'' <br /> Ot i € tONSANP OORREJJ' ACfiiQ+tS.;. <br /> { 10\ <br /> u�- tv <br /> Itirttoation eipti atm: # f t sane} Temperature <br /> �C3 •n� � � <br /> ;G>?ri3tiinac �ti 3 ?t fiVati:t`1eiri <br /> ..refute War. vai�g. <br /> Name: Hand Sink: �f� ofChlorine: ppm Heat: of <br /> Exp.Date: arkwashing S' k: <br /> 12-() of Quat.Amm.: ppm ther: _ of <br /> h C <br /> Received By J Title: <br /> EH Specialist: Phone: <br /> Time in: (1 ; Z� Time Out: d : Page (of <br /> "7 f <br /> J <br /> EHD 16-24 (2nd pg) 413113 FOOD PROGRAM OIR CONTINJATION <br />