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at+4klN••c SAN JOAQUIN COUNTY <br /> ?; ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> da.... .:.;e Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> �1FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U 4 D n G ry, e r y Date: - /Z <br /> Address: ' h S1 C r4 C Zip Code: L <br /> caner/Operator: 4h$e �-? G ✓1grf�U �-fir Telephone: - 7v `I <br /> n 11- <br /> Program Element: Program Record: Inspection Type: <br /> g L 3 g 31 4 12r ; n3 Cc J; r <br /> 8180 Posted 0 Yes 0 No Permit Posted 0 Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o un <br /> '- Item!Location '' <br /> 7a .e ! ac as inName: r �- Hand Sink: .-. .. .F hlorine: PPM eat: •F <br /> r <br /> Exp.Date: `/ ol- are m Sink: "F uat.Amm.: Gi U PPm then. `F <br /> EHSpecialist: <br /> d By I Title: ���fff d- <br /> P e. <br /> Time Out: Page of <br /> FOOD PROGRAM OIR CONfINUATION <br /> EHD 16-24(2n°pg) 111209 <br />