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SAN JOAOUIN COUNT <br /> .o <br /> �: . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .•„ ..�;;p Telephone: (209) 468-3420 Fax:{209) 464-0138 Web:www.siclov.org/ehd <br /> �1 FOR <br /> i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /— r O Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: r Telephoner <br /> Program Element: Program rd:' �S lJ.� C Inspection Type: / <br /> 513180 Posted es No Permit Poste s No Re-inspection on or After: <br /> % : .. ©B$ RVATlONS''AND,�{3RRCTIVE�►CT1ttS <br /> v I <br /> /-- <br /> l <br /> t <br /> - °'�"�°”` ltemlfrveat3on. `�"� �'1"em Estate `�';�;°'";� IteiYt/�.ocation Terri�erature' <br /> safety st � ct#art ..w'`. ,.w ar ility Hot Water Teinperatute 1Narewashing <br /> . _ <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppmOther: of <br /> r <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: /�,• Page;rf <br /> EHD 16-24 {20°pg} 413+13 FOOD PROGRAM OIR CONTINUATION <br /> , I <br /> E <br /> 1 <br />