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� f <br /> a4aU'" c a ✓(; SAN JOAQUIN COUN'�j <br /> �.••��-•-o ltl <br /> q Zi ENVIRONMENTAL HEALTH DEPARTMENT <br /> 7i <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .• q• a` .. � 30 Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> tIFpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U Date: Z aC <br /> -� Address: City- `+ Zip Code: <br /> Ft <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type• <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> _......................... <br /> 5 , <br /> 77-t-s <br /> I <br /> s^ _. U 4 <br /> L 2C7 <br /> L 12D t <br /> 1 4- <br /> 7-1) �,O_ e 5 . <br /> S <br /> t D 1 ;e [ SS e El <br /> ,,. _ _ . <br /> ` Name: Hand Sink: of hlorine: ppm Heat: of <br /> 77— <br /> Exp. D arewashing Sink: of Ouat.Amm.: ppm Other: ofd <br /> Received By 1 Title: <br /> EH Specialist: Ems'- Phone: <br /> !me in: 1. © — Time Out: V > Page of <br /> END 16-24 (2nd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> + <br />