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SAN JOAQUIN COUN', <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4., _:�;�P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \�- } -; �- ' - ,c;s ( `o &„ j_ Date: _ - <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: \( - S Program Record: 15v-:f &5-s- Inspection Type: 7- <br /> B180 Posted `U ❑Yes ❑ Rermit Posted ❑Yes ❑( Re-Inspection on or After: <br /> ,�`�` a P111111, <br /> •�a _u, ,_�_ ,a ��a <br /> OBSERVATION ANd CCU RESTIVE ACC I©. <br /> 10 r . <br /> C�� <br /> QQ C, <br /> \DSO <br /> t 1� - — <br /> �s1� <br /> S; Ae <br /> C, ? 1 C O <br /> C— T <12 <br /> h _ h <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: -F uat.Amm.: ppm ther: "F <br /> Received By/Title: <br /> EH Speciali Phone: <br /> Time in: C( I Time Out: Page. of <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />