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aP p'"• SAN JOAQUIN COUNTY <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... c . ;p. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sig v.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: a i S City: / ,� Zip Code: <br /> Owner/Operator: (� Telephone: <br /> Program Element: Program Record: '� /Z Inspection Type: w <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ��YIS <br /> vi !iN2 I �yvrhK� <br /> o� S vowS e i u� L <br /> ��S s <br /> _ Item/Location ra[ure <br /> L41 - <br /> F OW <br /> Warew <br /> Name: Hand Sink: aP Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: PPM Other: aF <br /> Received By/TRI <br /> EH Specialist: - �_ Phone: <br /> /a _ <br /> lcime in: ✓,,, h Time Out: I I I Z '3Page of <br /> EHD 16-24 (2^n pg) M3/13 FOOD PROGRAM OIR CONTINUATION <br />