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SAN JOAQUIN COUNTY <br /> x ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �;.. - :P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*qov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ti / Date: <br /> Address: O City G Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: M 5 Program Record: lb R V��D .2 Inspection Type: op <br /> 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> c� <br /> C <br /> -- "1 V_ <br /> L�w1a��► '1 - - -r< L"br-- <br /> s a c <br /> 'Qj <br /> v <br /> SOD <br /> RN <br /> a `tIpf►�e1 rI�It kllre `f$ � ' a �M� h� w <br /> Name: Hand Sink: OF Chlorine: ppm Heat: OF <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: I Z !f tG� Page f <br /> EHD 16-24 (2nd pg) 413/13 ! FOOD PROGRAM OR CONTINUATION <br />