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SAN JOAQUIN COUNTY <br /> z., ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> � • �� � Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s ov.or lehd <br /> t��OR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t �� G n Q �,� G �VIQ Date: �— <br /> Address: l(o S 'i �V Q �i City: �fiOt.�` Zip Code: <br /> Telephone: <br /> Owner/Operator: S`�,,� <br /> Program Element: 27 Program Record: S� 00 T q�W Inspection Type: Can Su <br /> 6180 Posted C Yes [I 17ermit Posted L-1 Yes 17 1 Re-Inspection on or After: <br /> ti Th.� p•+ped Gt-1� �. _- � C�'4�p --�iCl I' �� two �- G�1'-� �� �� <br /> - <br /> �� , unca9 <br /> i- uO-�er GSA- -m�.- - a� 4 C1 k&� <br /> tz 1UUF - <br /> 3 IAU$ Sln L Qt_ cb�-� <br /> �-o 1? CC/,(- <br /> MV-1 <br /> i - <br /> urq-1 Clue CA VN pCUVCf- <br /> 6 fia -S.S - � Gf _ tfi.e dee. _ c)6 <br /> ibita � fs: rta f mon Temperature <br /> I�oiuf Shy� �t �� �tafi>�ir�' r��ur� r+IC� sfa� <br /> Name: Hand Sink: 6,a of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: �r�, !� of Quat.Amm.: ppm ther: 'F <br /> Received By!Title: ALJ <br /> EH Specialist: Phone: <br /> Time in: l� :r,2 Time Out: r i�� �d Page of <br /> EHE 16-24 (2otl pg) 4/3113 1 F000 PROGRAM OR CONTINJATION <br />