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, <br /> 4 <br /> SAN JOAQUIN COUN Jk <br /> ENVIRONMENTAL HEALTH DEPARTMENti <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c� m ;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s' ov .or lehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S'� Date: <br /> ddress: City: Zip Code: Ci c5 3 <br /> b IS y e. <br /> OwnerlOperator: ; v Telephone: G 2 G <br /> Program Element:..1b �3 Pr ram Record: 1 O-Z inspection Type: 1 <br /> 8180 Posted ❑Yes ❑ Hermit Posted ❑Yes ❑ I Re-inspection on or After: <br /> - Y yY ,;n m'::k9:°8..... ..&1°te��x.a:'••:...*�.a'.:419•» -< ...,m. -.......-«:.,..�. -..:..,._.... .�,:..,...... <br /> Is <br /> - L <br /> r <br /> 5 ; <br /> C --ZiN <br /> s _ MCjr7SC4 q0__-3 <br /> C P- <br /> �_ �_ i - <br /> � <br /> L a--,- c- t tot 3 <br /> r <br /> - ` °L,3 <br /> i s m cv <br /> - aam <br /> e < <br /> Name. Hand Sink: 11 'F Chlorine. Ppm Heat: 'F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: Ppm Other: 'F <br />} Received By!Title: ` I <br /> EH Specialist: Phone: 4 (D � <br /> Time in: ` 1 Time Out: �r�� Paged of <br /> EHD 16-24 (2','pg) 4013 L F00D PROGRAM OR CONTINUATION <br />