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SAN JOAQUIN COL 'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> tiFoaa <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 /> 777 <br /> 777- <br /> 7 r? 00, <br /> JIE3S WNW <br /> ISIS AND CQRRECTIVE ACTIQNS; <br /> -r I M_.� - <br /> Me.c. <br /> Nd � Q' r L1`� v,\\\ U C� <br /> Iz QOM $I 1) <br /> 0V eS CYVN Q <br /> �0 <br /> C3 �C Is+�G oil <br /> �Q aUv A2 Oi m t)CW CdvGf <br /> moi\) C <br /> tsu w I-A W64(PX )• c n n cAej <br /> WNW <br /> III 7iiii : ii : : ' M <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: L <br /> EH Specialist: Phone: <br /> Time in: Time Out: tJ��l Paged_of <br /> EHD 16-24 (2nd pg) 4/3,13 FOOD PROGRAM OIR CONTINUATION <br />