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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.. �;;p• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.smgov.org/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 7 <br /> Address: City: W 44 Zip Code: <br /> Owner/Operator: t <br /> ( ✓�'� lel (-- Telephone: <br /> Program Element: Program Record: f, J Inspection Type: np <br /> SB180 Posted)CYes ❑ No Permit PostedNres ❑�No l Re-Inspection on or After: <br /> OBSERVATIONS ANb CORRECTIVE ACTION <br /> I vu ✓ ol.� -- - <br /> c l CIL 1 v <br /> �J'r Gl l Z <br /> W 4 It--cr\ <br /> dl,(J J r <br /> / to 01 <br /> Name: 0� �arewashing <br /> d Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Sink: -L of Quat.Amm.: 3 ppm Other: of <br /> 11 <br /> Received By/Title. <br /> OLI <br /> EH Specialist: S ryjii/ Z Phone: Cy S <br /> Time in: / Time Out: ( Page2of <br /> EHD 16-24(2n'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />