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oPa "•. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cgeiFona;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 qh V,/G Date: I D I} <br /> Address: City: Zip Code: <br /> Owner/Operator: v`1 v1 Telephone: Liq2 <br /> _ l <br /> Program Element: Program Record: O c - A—WWO <br /> I pection Type: 11sit t <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �htS <br /> N e^n( uSk e -rAND G <br /> A?*' U <br /> Item/Location i Temperature Item/Location' Temperature <br /> Food Safety Certification' Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: <F Chlorine: ppm iHeat: <p <br /> Exp.Date: arewashing Sink: aF Quat.Amm.: PPM Other. <F <br /> Received By/ itle: <br /> EH Specialist: Phone: A�sr_ -34-4k c 4- k <br /> ime in: 11: Time Out: + �f _I Page f <br /> EHD 1624 (2w pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />