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5i41N„ ►-.e SAN JOAQUIN COUN-,f <br /> a' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> +ci�dd;4. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4oy.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: rG S u S IN. 5 n 7 Wq Date: .r- / <br /> Address: <br /> 1 c G 1 I Itn S r City: Tr _t C Zip Code: y,5 3 7,4 <br /> Owner/Operator- Telephone: 63�; 20c <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted - Yes - No Re-Inspection on or After: <br /> CTIVE ACTIONS, <br /> n s rosrdc-rti efe 1 <br /> 3 <br /> fety Cerf 9, » Facility Hot Water Temperature W <br /> .,. <br /> ame: Z 4J Hand Sink: .,F Chlorine: PPM <br /> Heat F <br /> Exp.Date: 'a, '.2 / -;i- arewashing Sink: "F Ouat. Amm.: PPM Other: of <br /> Received By/Title: O(" <br /> EH Specialist: Phone: /- <br /> !me in: ; IU Time Out: (' -V Page of 2- <br /> EHD 1624 (2°pg) 4/13'13 FOOD PROGRAM OR CONTINUATION <br />