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SAN JOAQUIN COUNTY ' <br /> 4 ENVIR .NMENTAL HEALTH DEPS ;TMENT <br /> COMPLAINT <br /> x f 600 E. Main Street,Stockton, CA 95202-3029 <br /> � Telephone: (209)468-3420 Fax: (209)464-0138 Web: www.sjgov.org/ehd COPY <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> II Name of Facility: I Date: <br /> 'z <br /> i' Address: City. - Z'�o e• <br /> Owner/Operator: [ephone: I <br /> I <br /> Program Element Code: Program ecord : p j �r� Inspection <br /> SB180 Posted Yes i_I No Permit Posted es IJ No y Reinspection On or After: <br /> I ` <br /> F .� _� - ��k� .v�.•d�._. -.UBS�RYATIQNS AND COREiECTIVE;AMIES;1�S <br /> I <br /> 47 <br /> W4 401 <br /> I <br /> f / i <br /> I I <br /> P _ <br /> e <br /> i <br /> I 7i <br /> • - I <br /> i <br /> I ` ! <br /> i <br /> I <br /> i <br /> } I <br /> � � l�er�"l�.otlnn,•• R, :; _..�Tem ...... i ..._, ffeml,�,oc.�tlori <br /> Y of <br /> Certiticat�onr �n�-. _,!��,.Fa�ili H Yflaler.Tem'i4iarature� �:� _ �. z. fi°War�nrash�g _ •�,- ------- � <br /> Name: Hand Sink: °F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: °F Quat.Amm. ppm Other: ppm <br /> 1 ENVIRONMENTAL HEALTH AND SERVICE CHARGE FEES ARE AUTHORIZED BY RESOLUTION OF THE SAN JOAQUIN COUNTY BOARD OF SUPERVISORS. <br /> ALL DOCUMENTED CRITICAL HEALTH VIOLATIONS OR REPEAT VIOLATIONS ARE SUBJECT TO A REINSPECTION AND REINSPECTION FEE. <br /> i <br /> ` I <br /> Received By: � Title: - <br /> II EH Specialist: Phone: Lq ra3; <br /> Time In: Time Out: 1 '� d Page: r Of , <br /> EHD 16-23(2NO PG) FOOD PROGRAM OIR <br />