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orgH1N. '%.W SAN JOAQUIN COUNTT-1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> ... r Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Gt7 C Q Z Date: 0 3 — .r- <br /> Address: O� E City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: S— Program Record: Inspection Type: <br /> B180 Posted Pes ❑ No Permit Posted KYes ❑ No Re-Inspection on or After: <br /> a �7 i3 ao tt S.e <br /> �Jr2 rrl S_ env <br /> emp rature` ":,tem 1 Location ." perature Item t Locatio` '' Temperatd"-:" <br /> Name: ^f Hand Sink: BOO r =F Worms: ppm eat: =F <br /> Exp.Date: I_ ewashin ink: -F rust.Amm.: Ppm ther: =F <br /> Received By/Title: cL .SCA <br /> EH Specialist: one: <br /> Time in: = S Time Out: PaA�f <br /> EHD 16G24 (2-pg) 11009 FOOD PROGRAM OIR CONTINUATION <br />