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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> P: -1 <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. iP Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 94jF0ry� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `. �5Date: f <br /> Address: �./ City:�x Zip Code: <br /> Owner/Operator: TelephoneO� <br /> Program Element: Program Record: � j Inspection Type: <br /> SB180 Posted B-Y� 1I No Permit Posted []Yes ❑ No Re-Inspection on or Aker: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ::.g, .`rs k:tem7L4 tib �^ i ; �,•'� .' .� e` - -rau e' <br /> r• /� a <br /> mor <br /> Name: �i� /C Hand Sink: �j� /' - aF Chlorineppm Heat: of <br /> Exp.Date: / /ate arewashing Sink: 7 of uat.Amm.: PPM Other. of <br /> I <br /> eceived By/Title:H Speciali Phone: <br /> ime in: // �U ( Time Out:/w, / Pages of--) <br /> EHD 16-24 (20 Pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />