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SAN JOAOUIN COW <br /> �° •foo <br /> a` a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> 4L�FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G r Date: <br /> Address: /f /i City: Zip Code: <br /> Owner/Operator: / Telephone: <br /> Program Element: Prog am Record: 7/ Inspection Type: <br /> SBI 80 Posted"'Yes ❑ No Permit Posted Z•Yes ❑ No Re-Inspection on or After: <br /> -� <br /> 01, , <br /> �fenln C7__ <br /> empecature. <br /> Food.safety Certificate <br /> Name: U Hand Sink: / 7 of hlorine: ppM Heat: of <br /> i <br /> Exp.Date: arewashing Sink: ua <br /> /\ a of PPM t.Amm.: Other: of <br /> Received By/Title 1 <br /> EH Speciali Phone <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />