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SAN JOAQUIN COUP <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q' 2 <br /> 1868 East Hazelto v nue, tockton, 95205-6232 <br /> c,�iFoa�;p Telephone:(209)468-342 Fax:(209)464-0138 7 •www.siaov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J' Date: ` //— <br /> ddress: / City: - ZipCode: <br /> wner/Operator: If Telephone: <br /> Program Element: Program Record: , Inspection Type: <br /> B180 Posted []Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> f <br /> f <br /> c <br /> �j <br /> IIID <br /> 'ility Hut' <br /> ame: Hand Sink: F hlOrine p eat: =F <br /> Exp.Date: arewashing Sink: F Ouat.Amm.: PPM Other: of <br /> Received By/Titley <br /> EH Specialist: / _ Pho <br /> Time in: Time Out: Page f <br /> EHD 16-24 (2-P9) 4I 13 FOOD PROGRAM OIR CONTINUATION <br />