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1 <br /> aa�a �o SAN JOAQUIN COU1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 l <br /> .. y �a Telephone:(209) 468-3420 Fax:(209) 464-0138 Web: A ww.slaov.o�/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date- <br /> Name of Facility: <br /> ddress: � __ City: Zip Code: <br /> owner/Operator: + Telephone: <br /> Program Element: l Program ecord: Ins ection Type: <br /> 6180 Posted es ❑ No Permit Posted es ❑ No Re-Inspection on or After: <br /> s y <br /> of 4 <br /> i <br /> 3 J MA41 <br /> nil <br /> s <br /> i( <br /> li <br /> 0 <br /> iF <br /> -- --- - - � 'tlT,uBILH1= Gll: 61� El�fiCrI1eT`dtlli� .<. m mm - RC$ �5llt'1�r <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phon : 03 <br /> ime,in: Time Out: Page-lof <br /> d'" <br /> FKD 16-24 (2^d pg) 4IW12 iy FOOD PROGRAM OIR CONTINUATION <br /> I` <br />