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x "ate" Ao 1./ SAN JOAQUIN COUk W <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �a•.... ..-:a Telephone: (209) 468-3420 Pax:(209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> [Name of Facility: DateCity: Cdeer/Operator. h Telephone: <br /> ram Element: Program Record: /oSD/ Inspection Type:�� .T0 Posted it n <br /> []Yes ❑ permit Posted V ❑YesO lr❑1 ry Z /p Re-Inspection on or After: I��ty�Z <br /> pibni, a a <br /> CiAftq ' uia <br /> u.w Gti <br /> c a <br /> Lt�(41 \k Kd rJ <br /> nn &Wfk LP10 (CIA <br /> Name: and Sink: `F hlorine: PPM eat: 'F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: PPM ther: 'F <br /> Received By 1 Title: <br /> H Specialist: Phone: <br /> Time in: - - Time Out: IPage�f <br /> EHD 16-24 (2-pg) 413113 FOOD PROGRAM 01R CONTINUATION <br />