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SAN JOAQUIN COUNW <br /> 2. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> C! dHt' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G Date: 'T-1 7—+r 2 <br /> ddress: �,{��— ��.,.. v or, city: , Zip Code: <br /> wner/Operator: Telephone: <br /> Program Element: ` ,3 Z� Program Record: I 00 Inspection Type: <br /> 8180 Posted yWes C No Permit Poste es ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> IJ O la 'c, <br /> Item/Location: Temperature Item I Location Temperature _ Item I Location Temperature <br /> Wa L- I � -_� _ - _ I <br /> Facility Hot�,perature Warewashing <br /> Name: .7e(�r )2CD Hand Sink: Chlorine: ppm Heat: `F <br /> Exp.Date:: 6 _ z _ S arewashing Sink: 13y 'F uat Amm.: ppm Other:- "F <br /> Received By/Title: C _I <br /> EH Specialist: KkLPhone: 446 - t4t-157__ <br /> Time In: : y S Time Out: I Z; 2 Q Page2-of <br /> EHD 16-24(2n°pg) 4)9/12 FOOD PROGRAM OIR CONTINUATION <br />