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SAN JOACQUIN COU. f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> C4<<FORN�P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sl4ov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: f <br /> .,r� c; S •poi� ;- _, rU, %l1 <br /> Address: s-s- //,. rr City: ` Zip Code: q <br /> Owner/Operator: ; — T �G� T. ` Telephone: <br /> Y-35 7.2� , y <br /> Program Element: 160.2- Program/ Record: y ll Inspection Type: <br /> F18-0 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> � a <br /> r �UC'% IS C+ ma pe tC <br /> Q' + 1UfN c t of s (� �1 c� ✓e .'I <br /> Z '7 14" G' G- d� C +c r'r 4. <br /> �UG r 7W4r <br /> W t+r ✓✓)er <br /> i5 k4 ' �'a�" , UUP <br /> t W <br /> n' Facility Hot W;g :x> warevirr„ <br /> ..",. , <br /> Name: Hand Sink: 16 of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 7116 <br /> Time in: /,� • Time Out: U /t/ Page of <br /> EHD 16-24 (2n1 pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />