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7 PaurK SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> rR :4 Telephone: (209)468-3420 Fax:(209) 464-0138 Web:www.si-gov.org/ehd <br /> c�xoR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Date: <br /> ddress: - <br /> �7 3 City: Zip Code: <br /> Owner/Operator: c "k - Telephone: <br /> Program Element: ) Program Record: �+, i7 t r Inspection Type: <br /> B180 Posted l ❑Yes C] Rermit Posted vV wEl <br /> Yes ❑ I Re-Inspection on or After: <br /> m <br /> ` J1z LA) e- <br /> a` �u <br /> - G&tn ceK ✓U <br /> vCqAA oflt,� <br /> I��-Pat G <br /> l�ych- <br /> 1� �- • <br /> P a'1'1 , <br /> OA-- .40 � &al LkK VVAAVM <br /> La= <br /> raf4-< - r bion. Fete .. <br /> y m m m <br /> e <br /> a <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm Other: `F <br /> , <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> Time in: ` f <br /> Time Out: �Pag�ejo <br /> EHO 16-24 (2"d pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />