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SAN JOAQUIN COU�I( <br /> +� X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95208-6232 <br /> `a• :� Telephone: (209) 468-3420 Fax_ (209)464-0138 Web:www.s ov.or lehd <br /> �rFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Date: <br /> ddress: In til City: Zip code.- <br /> Owner/Operator: S <br /> Telephone: <br /> Program Element: Z Program Re ord: SZ� .7 V Inspection Type: <br /> YS <br /> IS 8180 Posted Li Yes ❑ Permit Posted ❑Yes LiI Re-Inspection on or After: L <br /> rti • e C , <br /> vlD'_ yv f� r, kk1 -w <br /> c ova-�• - - <br /> 0'qe and .�j 1 v A lcovt Wvf'6 <br /> J <br /> r > r <br /> Name: Hand Sink: -F Chlorine: ppm Heat: °F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm then: 'F <br /> Received By!Title: <br /> EH Specialist: Phone: <br /> ime in: Time Out: I Page of <br /> EHD 16-24 (2"pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />