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SAN JOAQUIN COW <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.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Gi (, i7 u( 7 I Date: I V C <br /> Address: e)- 1 City: fz)�tm Zip Code: <br /> Owner/Operator: 7J/J.r,U Telephone: <br /> Program Element: /_-3 Program Record: 1�2 �( I Inspection Type: 'cJnn' <br /> B180 Posted �'GG Yes ❑ Rermit Posted Yees ❑ I 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I Y O CAC19 Q1V be6T'L(_ ow I fill <br /> r.� cm wlc� <br /> c U C*-CJQcans . <br /> - - - Y U U is5,5k 2, -p:QiR l ivr 20 <br /> f10u. ar up S� <br /> Temperature Item J Location � Temperature <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> - <br /> Exp. ate: Warewashing Sink: of Quat.Amm.: ppm Other: F <br /> Received By/Title: <br /> - - - - <br /> EH Specialist: Phone: O nom] , (o ­ <br /> Timeime in: Time Out: , too lJ Page of <br /> EHD 1624 (20°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />