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ora"'" SAN JOAQUIN COb aY <br /> s.•-�••.ot �LJ�C,. <br /> y` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �R.. 1 s;.,.•;a• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.oralehd <br /> {�FaR�► <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 8` 1 -7-1 <br /> ddress: 12 City: Zip Code: 9 �i <br /> Owner[Operator: C O2 1 <br /> Telephone: Ste" \A <br /> Program <br /> Program Element: 1�ZS Program Record: \<> Inspection Type: <br /> B180 Posted E Yes E Hermit Posted n Yes 12 1 Re-Inspection on or Atter: <br /> . C 1 -T . <br /> J <br /> J <br /> 1_ <br /> Jul. <br /> 5 _ c <br /> _------------------...-I-._._.... _.. -- ---- -------------------- <br /> Fc <br /> - --- <br /> Ftd. si' tD .Flc►tira€srerp €+ iAiarli�aitli ;. <br /> Name: Mand Sink: ofChlorine: ppm Heat: 7 <br /> Exp.Date: arewashin Sink: 11 of Quat.Amm.: ppm Other: 'F <br /> Received By t Title: i 1 <br /> EH Specialist: l•� Phone: � b �3 - <br /> time in: I 1 r _ Time Out: ��. �5 Pag&f3 <br /> EHD 1624 (2' pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />