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P4"'" SAN JOAQUIN CO. TY <br /> Q` �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... _ ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slQov.orq/ehd <br /> 4L�FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION, REPORT <br /> Name of Facility: ;(� X( cc'1 GC 1} `C� �� I CIIaU(t� Date: <br /> Address: C� 1U (� City: Sl u Zip Code: <br /> Owner/Operator: 0 GA6 I 1 S Telephone: <br /> Program Element: � Program Record: Ir Inspection Type: I (� <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> JiCUC -rte C van S cm-t i-' cct}-e &C) c1A\j c - <br /> Ulf C51h e,(- X'I 610 dY- cc -r.eC-4 --- <br /> tzA- � <br /> i <br /> Item/Location Temperature item/Location Temperature <br /> Food SafetyCertification FacilityHot Water Temperature Warewashing <br /> Nmea : _ Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Titley <br /> EH Specialist: Phone: 2 �G <br /> ime in: '{ Time Out: , 2 U Page'of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />