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SAN JOAQUIN COUR <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> �l FtikN <br /> M <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - Date: <br /> Address: _ City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> —' OBSER 4V� <br /> rN TIANDaC(flRREC7IVEy�C ONS <br /> 7 ------------------------------ <br /> " ,a..z. lemfLocaUo . .. Pmperaie ,;:,. .r_. ,.,�__a ;.7temGocaiwn ;;- ..,, 7iepekatura� <br /> od5a#ety�C2r31f'Ca on.' �-Facd)ty F3�otANa <br /> „u a - <br /> '" _, 7FIChlorine: <br /> Name: Hand Sink: PPM Heat: of <br /> Exp.Date: arewashing Sink: ofOuat.Amm.: PPM Other: of <br /> Received ey <br /> EH Speci list: 1G Phc L��J <br /> ima in: Time Out: Pag of� <br /> EHD 1&24 (2-pg) 4rSI3 FOOD PROGRAM OIR CONTINUATION <br />