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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c°Wo-p��a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 9 Date: <br /> Address: City: ti C,. zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I S Iva <br /> r <br /> r <br /> — atlo" T. ar".ature <br /> 1teiNLoc>9 ton -- <br /> Food Safety Certiflcat " ao Y erewsshln <br /> Name: <br /> Hand Sink: °F hlorine: ppm rth <br /> t °F <br /> Exp. Date: <br /> arewashing Sink: °F uat.Amm.: ppmer: 'F <br /> Received By I Title: ( G <br /> EH Specialist: a r Phone: 3QS Z <br /> Time Out: Page of <br /> ime in: <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16.24 (2nd pg) 413113 <br />