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SAN JOAQUIN COUN _ <br /> •.OG <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 /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I m G 1G'�C O 7, 7� _ -7 7 2 W Date: I <br /> Address: S1 ?ice City: �, <br /> c�j� r Zip Code: <br /> Owner/Operator: m UG n U Q Telephone: <br /> Program Element: I SOU 7 Program Record: S LU­7 IQQ� Inspection Type: <br /> 6180 Posted ❑Yes ❑ Rermit Posted F.Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r Th(z owl" 1G CAA- <br /> (11 <br /> ad <br /> 2 �I' CA go 'S �� C��rfica� � n u U <br /> cr QP6 t-066 h h b lam- ( CIO JOI CA c ;gym 71 <br /> t6 �swk <br /> 0 lice Pt _ V;55 <br /> Name: an Sink: of hlorine: ppm Heat: of , <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppmOther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: Time Out: Pag of <br /> EHD 16-24 (2n0 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />