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� •.OG <br /> SAN JOAQUIN COU Y <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT ` <br /> Name of Facility: Date: I6_ <br /> ddress: /), , City: - Zip Code: <br /> Owner/Operator: ��/�` �Y �R Telephone: <br /> Program Element: 3 Pro ram Record: 6) Inspection Type: <br /> �6180_posted Yes ❑ Rermit Posted /Yes ❑ t I Re-Inspection on or After: <br /> 51 <br /> _. OBSERVATIONS AND CORRECTIVE ACTIONS, <br /> 1 <br /> l�z '�:6�tiG ✓t.v <br /> Y\�i.w•t. <br /> i <br /> Item 1 Location T <br /> mv <br /> L� /L <br /> ` 3 <br /> tia # 1iltarewastmg . <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: 'I Z arewashing Sink: of Quat.Amm.,jp„-qp ppm Other: of <br /> Received By/Title: Il/�� <br /> EH Specialist: Phone: �- G <br /> Time in: ? Time Out: ( Page�f 7 <br /> EHD 16-24 (2no pg) 4/3/13 ) FOOD PROGRAM OR CONTINUATION <br />