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i <br /> i <br /> SAN JOAQUIN COUr <br /> w ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c - Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> R{ikii'�`� '• <br /> i� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a r A Date: <br /> _gzj A&62 <br /> Address: - City: f Zip Code: <br /> LC Lle> <br /> Owner/Operator• Telephone: �r <br /> Program Element: Program Record: Inspection Type: <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes 01 Re-Inspection on or After: <br /> �y#�, e. <br /> U-S, NOUN <br /> m <br /> IA <br /> r <br /> n �. <br /> t � <br /> r r <br /> S <br /> able <br /> I ai <br /> ,Ii_ <br /> ' 'A-C? <br /> C i I/ n <br /> V r r Q 1 <br /> II <br /> Not <br /> i' <br /> .:. .,... ':.. <............. ". 'obi.,. <br /> Name: r). Hand Sink: r Q of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: I( of Quat.Amm.: ppm Other: o f <br /> Received By 1 Titl <br /> EH Specialist: `-� f Phone: lq z <br /> !me in: Time Out: Page of <br /> ~ 1.140 <br /> Q <br /> EHD 16-24 (2n°pg) 4013 FOOD PROGRAM OIR CONTINUATION <br /> II <br />