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SAN JOAQUIN COUN. Y <br /> P <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> C/FOM1 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G 11 Ilt /,� ..r1 Date: 3-��(_ 13 <br /> Address: �).� City: -I/a I Zip Code: <br /> caner/Operator: Telephone: �3 y - <br /> ( Gr 0(6 lylon la.%, I-[nci 2-1 f <br /> Program Element: (/ 2 5 Program Record: (6 4 Y Inspection Type: <br /> G O <br /> 8180 Posted -Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> Y [ <br /> y- f Or <br /> docc) jq 1 F <br /> Name: Hand Sink: "F hlorine: Ppm eat: 'F <br /> Exp.Date: Warewashing Sink: "Fuat.Amm.: ppm ther: `F <br /> Received Sy/Title: <br /> EH Specialist: Phone: <br /> Z u ✓� <br /> ime in: Z Time Out: Page of <br /> EHO 16-24 (2n°pg) 4/9/12 FOOD PROGRAM OIR CONTIN ATION <br />