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°u'" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �; �FOR�;;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �_ ! elC Date: <br /> Address: City: 1 '4)e,4eZip Code: <br /> Owner/Operator: 2� , Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes ❑ No Permit Posted Yes D No Re-Inspection on or After: <br /> a <br /> OBSERVATIONS, D.CORRECTIVE,ACTIONS ,.. <br /> . _ <br /> Gv <br /> 0171: tOI <br /> PIP-, Z <br /> S yZ6 14Gt n <br /> S L t Pn1rA- <br /> I <br /> V1 G <br /> —rpPs - fnldw <br /> / Gt< �i <br /> /,� yip ��► u�� � Vi 9nI- i cl�7F <br /> J <br /> Name: Hand Sink: '� OF Chlorine: ppm Heat: OF <br /> Exp.Dat Warewashing Sink: OF Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: l ✓ Phone: <br /> Time in: Time Out: i Page_of <br /> d <br /> EHD 16-24 (2n'pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />