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0, C,c SAN JOAQUIN COU. f <br /> :a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c•.. . :P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> 9Cj F p'�ta <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: f,i-i, sL LT City: Zip Code: �LjZ <br /> Owner/Operator: lC Telephone: <br /> Program Element: Program Record: .L��� Inspection Type: <br /> B180 Posted es No Permit Posted Yes No Re-Inspection on or After: <br /> i <br /> wM <br /> lti0 <br /> 5 <br /> c. r_*,_ ti s 6 ZO <br /> 58fBty ra �.:. <br /> IF 14 fiQ[YVtater T�tnp�i8 11C� tt�rtg <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: a ))�j' Time Out: ./ Page of <br /> EHD 16-24 (2nd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />