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SAN JOAQUIN COUNT <br /> 11 o' •COG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siciov.org/ehd <br /> (FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r{ Dy\4ate: r(b <br /> Address: <br /> City:WvZ Zip Code: <br /> Owner/Operator: <br /> Telephone: GarW_o <br /> Program Element: \�0 C)o Program Record: (O l)G '(�)CA`T Z Inspection Type: ovA1 a4l <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: ll/� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> P� od . <br /> Uti 1 S Q w �t��t-i M (ThCG c h CA , C n-h(A <br /> T\qve 2 hood or G� a� vo\Ned �d to . <br /> C 4 � Md eat ) ", <br /> S .,e i f�r CMA <br /> Cid <br /> St4"e U<< S c& <br /> Name: Hand ink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> JA <br /> EH Specialist: Phone: �C6 _ <br /> Time in: Time Out: c� Page (of <br /> EHD 16-24 (2^a pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />