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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �;.: ;'adv • Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s ov.or /e d <br /> �IFOR <br /> O� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Ice '(&p Date: f <br /> Address: A•e ll �/ City: Zip Code: <br /> Owner/Operator: /� `� Telephone: 7�I <br /> Program Element: /„ Prografn Record: Inspection Type:C,',,, <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> VIAI �` 6 J / ` <br /> L ( TI Ke 0�_ rl�vur t_�1601 7(_� V Aq'11 <br /> f° <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: 777 7 arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: ix <br /> LG <br /> EH Specialist: �V r/ , Phone: !j/„ >— O�p� <br /> Time in: / Time Out:'7 (F'd" /V J/ Page, of ' <br /> 'r 11 <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />