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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95206-6232 <br /> Telephone: (209)468-3420 Fax: (299)464-0138 Web:www.s gov.org/ehd <br /> 4C11epR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> City: Zip Code: <br /> ddress: h ra <br /> Owner/Operator: Telephone: <br /> Program Element: �G O Program Record-- Inspection I1 �� Type: G <br /> � , n <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> "WA A S' <br /> om I�,,n yrs .c KA c, roo�'Yl: <br /> �c V ;S; �aCti l / ltSr�S leo J "Op Ps Cc/� dro�_ <br /> Fu �; i:+;► has hid r'Y? ;tP ; n �r�- u1r7Jo_S: q A <br /> a Cin rtr rt •- O P 5 5 S f�c�. 41,1 (/�1rr ao i f <br /> ftlei tali�it4 ;, 1 i L attic - i1 re <br /> _...- --------......................-.........- --------------------- .. <br /> Ptwxw T WlP.arew�taEng. <br /> Name: Hand Sink: "F hlorine: ppm Heat: "F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppmOther; -F <br /> Received By I Titl es <br /> EH Specialist: Phone: <br /> time in: ' - - Time Out: 2 Page' of <br /> r <br /> EHD 16-24 (2nO pg) 413113 FOOD PROGRAM OIR CONTIWATION <br /> S <br />