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SAN JOAQUIN COL Y <br /> �O .cOG <br /> Q \ ENVIRONMENTAL HEALTH DEPARTMENT <br /> --_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siQov.orq/ehd <br /> CfFOR <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 /> x <br /> C4eec..,e nov cavesT--,r s :einq ocvodcar 1 car <br /> pIcAW U 'th 1_rae CAAprffi�.e�. - (_U a-0� CCMAe <br /> and a Q11 _11FOOCK Cwt <br /> C40e z e, A "W Alf—& <br /> 'h2G GAAV a <br /> V.24+b,A( Me Ct f 12� u "�" -�b P)15f CIC ;..SCCVZ� 0W4e4_ <br /> � d <br /> Cts <br /> Qmpm� 6�.�e yy)ccp�a ed ccmoc� 1_�_ i-� 1R Ot &Gw <br /> CI i SQsfvi f1 <br /> M ik'j ,An--rh Y4'vi t Q v" <br /> w - vppd .Qvw d t <br /> d _ WG R M ViCA4ei— r v Q, err lv ft J�,v <br /> a . <br /> a <br /> �., <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: e�trQ_ r6 - ip <br /> Time in: Time Out: T Pag f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />