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wry... SAN .�OAQUIN COUNTY <br /> )� <br /> CGG <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • �q., c;..,;p• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r Date: <br /> Address: 3 O a} S. t/ Do rr, 610 City: S W Zip Code: <br /> Owner/Operator: (a r4 C Z Telephone: S (J 3 y l l <br /> Program Element: V I Program Record: S Inspection Type: n / <br /> SBI 80 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑No Re-Inspection on or After: <br /> BS TM AN `'C©Ft CT ACTIONS <br /> 0 S ' 0 nj CQrrac4eel - <br /> pro v ; _ �' a. CGS - h (ted <br /> C <br /> Oq <br /> e nl (j� Ore - - <br /> d e'm : v <br /> 77 <br /> Fo01"IMt Water Temperatur, <br /> -- - -- <br /> Name: and Sink: � of r <br /> hlorine: pp- o F <br /> Exp.Date: arewashing Sink: 3 of ruat.Amm.: ppm Other: of <br /> Received By/Title. �Yy�•L Lt� ►1�r <br /> EH Specialist: - Phone: <br /> Time in: 7 G Time Out: 7 Page of <br /> EHD 16-24(2ntl pg) 11/2/09 J FOOD PROGRAM OIR CONTINUATION <br />