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SAN JOAQUIN COU f <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;..• �;;P Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �lFOR <br /> /FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Of ��ViiL y'lC- �/li t 11 �( ,L� Vf- -i.Yt��4 , Date: /L <br /> Address: �_ � _�G City: Zip Code: <br /> Owner/Operator: uJ Telephone: <br /> Program Element: Program Record: Gf L Inspection Type:- . 0�e <br /> d Yes <br /> SB180 PosteNo Permit Posted Yes No Re-Inspection on or After: t/� <br /> k1 r- <br /> Vvl\ <br /> � . omi 77 <br /> amme - It !Locat n - Temperature <br /> !/L+ <br /> 3� <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of Ouat.Amm.• ir,) ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Pag of2, <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />