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OP4ulN' C SAN JOAQUIN COU' f <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q..• a�P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (> Date: '\/ 7 14- <br /> Address: <br /> Address: i ,V O 1C fn s City: S• Ly—izn Zip Code: /a�.`a C� <br /> Owner/Operator: t Telephone: "�44 -6q ?, <br /> Program Element: . Program Record: Cow 3)4-43 Inspection Type: �Lm Icitnfi <br /> SB180 Posted - Yes No Permit Posted Yes No Re-Inspection on or After: <br /> c1m 'ulnfi siz.��-e� Gbrs�it-vecl ����,¢ntsin 1ne �tA1% <br /> - Md c)-� observe c n\l "ve a is '�n AN, kiaCA' <br /> - <br /> 0b sewed -o+ \N <br /> � 1��nt�a�h est cGr�o i U a c; 4n �► i <br /> �a <br /> ,., W.o� emperature <br /> food Sa. <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: " Phone: OG_ 1( 2 h 4� <br /> Time in: 0 ., Time Out: 1 _ 4 --2>4 <br /> tet Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />