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,Q'a soG SAN JOAOUIN COUNTY <br /> { ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> L(fOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: N u�r CG' S Date: ' I `F-- <br /> Address: r�G.CD kycnok� wa City: S -}-gym Zip Coder <br /> Owner/Operator:�1 �,�,�v`` - C) ,V l 1 Telephone: f I <br /> Program Element: `ko'})2 Pro am Record: p Inspection Type: STV fi <br /> SB180 Posted No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ez w t m hcj un rcA-(LP..............-w wig s�r�s �,-�JCh 1� <br /> ........... <br /> ------ -------pA, �cmt i n o ca+ <br /> ec> <br /> Item/Location 1 Temperature Item I Location Temperature <br /> ....................- <br /> Food Safety Certification Fad— cility Hot Water Temperature War ewashing <br /> Name: j� `G Hand Sink: f ( (, 'F Chlorine: PPM Heat: F <br /> Exp.Date: �Z arewashing Sink: 12-6 of Quat.Amm.: ��r ' ppm (Other: of <br /> Received By/Title: j <br /> EH Specialist: Phone: -� <br /> ime in:Ci �l Time Out: , U• (� Page�of <br /> EHD 16-24 (22-pg)4013 FOOD PROGRAM OR CONTINUATION <br />