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f <br /> SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> t <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: " Date: <br /> ddress: f/V/,t/ / City: Zip Code: <br /> wnerlOperator: ! Telephone: <br /> Program Element: Program Record: ect'o y p� <br /> B180 Posted ❑Yes ❑ No Permit Posted ❑Yes [] No Re-Inspection oh or After: �Yy <br /> t r" <br /> CT� UT. <br /> " a QS &$8I�od-NS <br /> I vie � K v09 <br /> � <br /> F 1114 ij ty 11-r_ <br /> d c a cr C <br /> .. ` <br /> cc <br /> 1 a L°Gfit v� G►r SAvv' <br /> ;A l P <br /> i <br /> Per manlare- '%'P"f1w1fV ".�j �Nge- <br /> r • !-� <br /> c c , <br /> him- Alil it 4� <br /> 60- a r' arVA eii d{ dor * <br /> �- <br /> �t r f <br /> .......... <br /> .<.E.. <br /> C:et <br /> Fge'. <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: "F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm they: 'F <br /> Received By!Title: Y <br /> EH Specialist: Phone: C <br /> !me In: ' Time Out: r J Pag o <br /> EHD 16-23{21"pg} 11/06108 FOOD OIR CONTINUATION <br /> 4 <br />