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SAN .10AQUIN COUNTY <br /> �° � <br /> o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.so.ov.org/ehd <br /> �rFoa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: b � Date: _ _ ZE <br /> Address: 2�" \ City: Zip Code: <br /> Owner/Operator: _1 Telephone: <br /> Program Element: 1 Program Record: Cv b� Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> r4 ` z'R.vE��.F ���, ,� <br /> 2 <br /> 2 <br /> , <br /> 2 1 <br /> IF <br /> IS4-E <br /> 1 _ <br /> e atio - s e ure y � em � a <br /> C <br /> a O <br /> l <br /> 14 l <br /> Name: Hand Sink: OF Chlorine: ppm Heat: OF <br /> Exp.Date: \_ 1 _ ^ arewashing Sink: 2 of Quat.Amm.: ppm Other: of <br /> Received By/Title: C� \ <br /> EH Specialist: _ one: <br /> time in: -0 <br /> in: -0Time Out: ' V-C_ Page�f <br /> EHD 16-24 (211pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />