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�OP .CSG SAN .JOAQUIN COUW_ ' <br /> ENVIRONMENTAL HEALTH DErARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `_ ,� l ..G; ( Date: 511T <br /> Address: Q, j� City: Zip Code: <br /> Owner/Operator: r /l / vet( Telephone: <br /> Program Element: 2 Program Record: V / Inspection Type: <br /> B180 Posted l Yes ❑ Rermit Posted es ❑I G Re-inspection on or After: <br /> AA <br /> Item/Location <br /> u ;, !tern/Location Temperature <br /> IV NO (hiv- <br /> 1 ►. ,2 <br /> Name: Hand Sink: OFOF hlorine: ppm Heat: of <br /> Exp. Date: , /�� ( , , I1Narewashing Sink: 9 of IQuat.Amm.: ppm then. of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time Out: ti j Pag <br /> EHD 16-24(2ntl pg) 413113 l FOOD PROGRAM OIR CONTINUATION <br />