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SAN JOAQUIN COUNTY <br /> P • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd <br /> ��FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: '��( City: —� Zip Code: Ol 5 3 V <br /> Owner/Operator: �o Telephone: <br /> Program Element: \q� Program Record: S 1 l_C;1 Inspection Type: <br /> 6180 Posted v ❑Yes ❑ Rermit Posted ❑YeEsJ ❑1 Re-inspection on or After: <br /> OBSERVATIONS AND CORR CTIVE ACTIONS <br /> r: 7ft-,742- MD <br /> W 5 s; <br /> S � <br /> C <br /> -7,71,777 <br /> ' \ <br /> 1tE bCAti T Y.: <br /> � fifi <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By!Title: 5 SIJ /� �� n l\- <br /> EH Specialist: Phone: \ _� <br /> time in: ` 1 Time Out:"1 1. Page!,,of <br /> EHD 16-24(2-pg) 413113 FOOD PRO RAM OR CONTINUATION <br />