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SAN JOAQUIN COUN <br /> �O. .CGG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. iP• Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> qc;FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `,l f-- L( .4 jq(cam Date: / //'v <br /> Address: j City: Zip Code: <br /> Owner/Operator:! /: 1r!/, / G1 '�-- "a Telephone: �Yc` <br /> Program Element: �' I'v1P—rogram R ord: Gi Inspection Type: -+ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: / <br /> 02 k Y t kt <br /> vv� (a6f <br /> --� le CPJ <br /> C wt C G� if ).ter Ol 0-1.0 <br /> % lee `9'1 a —Itq <br /> !Y7 17yAt L L L C <br /> :169. <br /> rzp <br /> 010 9' v u ( kvq <br /> • n �( �rvt. .�ce <br /> zr <br /> Item/Location Temperature Item/Location Temperature <br /> ------- <br /> ---------- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink-.--- o F Chlorine: 6 ppm Heat of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: (�/L Phone: —G� <br /> Time in: 1 Time Out: ` P:gf <br /> EHD 16-24 (2°'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />