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SAN JOAOUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orq/ehd <br /> ��POR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4 G Date: / <br /> Address: 9 r�- City: t' Zip Code: 1?5 <br /> G <br /> Owner/Operator: r) / Telephone: <br /> Program Element: / <br /> Z Program Record: 1 33-5Inspection Type: <br /> S131 80 Posted Yes F1 No Permit Posted -]Yes R No Re-Inspection on or After: <br /> t � a OBSERVATIONS AND CORRECTIVE ACTIONS _ <br /> 2 .,_ <br /> L s L4o S- -1 - -- Ir 41 <br /> fl GA N CIA <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: ) <br /> EH Specialist: t Phone: /t� do--Y/� <br /> Time in: Time Out: ! Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />