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a¢RA ,A SAN JOAQUIN COUNT <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> d4.. P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G a u / I r C,( Date: <br /> 12 -6 - 12 <br /> ddress: I i, "1!^ 5 Cm'• l Ya [ Zip Code: 17 4 <br /> wner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: 90j r Q <br /> B180 Posted Ves No Permit Posted 'p)F6 "- No Re-Inspection on or After: <br /> ii-' ; de CA l: Ple tog 4u ;.n 4; toe <br /> con l ' I tic, r C he,0'3 b bod Out J ro: l.-rw YYo la re <br /> re l 4o a lirAo'i / it1r: 44,n Ic j ChNllz„ u <br /> ( d 61Is. w Or <br /> ulhrcc✓r1 ooY /1c � u // Se /f Clos : , Ccriee / <br /> � ' L eY, 2-00tvl CA lorne <br /> dacY Yr r i wo JL Urr- <br /> c1 4/O F <br /> ame: I �. Hand Sink: 10 v 4- -F hlorine: ppm eat: "F <br /> Exp.Date: 14 arewashing Sink: / Z Ll 'F rust.Amm.: PPM ther: "F <br /> Received By/Title: <br /> EH Specialist: Phone: j 6 d" <br /> !me in: 2 Q V Time Out: Pagel of Z <br /> EHD 16-24 (2i°pg) 4W2 FOOD PROGRAM OF CONTINUATION <br />