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SAN JOAQUIN COLIN) <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.s*gov.or /q ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Is Date: <^ s;-– <br /> ddress: t Z �� City: Zip Code: 9s Z C) <br /> Owner/Operator: C Telephone: '7s7_17 3 <br /> Program Element: Program Record: 4> 5 O Inspection Type: <br /> SB180 Posted �es ❑ No Permit Posted s ❑ No Re-Inspection on or After: 2 C_& <br /> OBSERVATIONS. D CORRECTIVE ANION <br /> 77.- <br /> aep <br /> 1. . <br /> G 42-e V 11'x ,1 "Ilk - � ar <br /> L. <br /> d <br /> .re-. i L-A wv,4 <br /> 5 T f &0 '0(- Vim - sl se v <br /> dk 1260-1 C o6pr 1n <br /> GIN-A%r o 3��F <br /> Name: �rl• q If Hand Sink: ( �� OF Chlorine: ppm Heat: OF <br /> Exp. Date: e6-2 _ arewashing Sink: I L� r OF Quat.Amm.: tioc) ppm Other: OF <br /> Received By/Title: rc �, <br /> EH Specialist: Phone: 44Gq_ 3 y t(c;— <br /> Time in: Lin Time Out: Z Page<,o!? <br /> EHD 16-24(20 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />