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SAN JOAQUIN COUN �( <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.: ;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.se oq v.org/eh <br /> LiFoa� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: � nd.\ Date: �j( 4 <br /> 1D <br /> ddress: 1"' Ci MQ Y 1 0 SG City: S�f.K 117JT� Zip Code: C K 710%, <br /> Owner/Operator: Gar 0 X /C-1Gtf �5.�V d Telephone: ��.� iorotb <br /> Program Element: t(p� Program Record: Nl 2 G (b t G. Inspection Type: •l U <br /> SB180 Posted Yes El No Permit Posted El Yes ❑No 7J Re-Inspection on or After: <br /> oBSERVATIONS AND CORRECTIVE ACTIONS <br /> w o4evzS U v- i\ °F , u 1'0 k2-O"- OT r <br /> tvdc� <br /> 7771 <br /> Name: Hand Sink: tGU 'F Chlorine: ppm [Other: <br /> eat: of <br /> Exp.Date: 7 arewashing Sink: �1 • 'F Quat.Amm.: ppm 'F <br /> Received By/Title: <br /> EH Specialist: Phone: 4 6 6 <br /> Time in: Time Out: (�:L Page of <br /> r„ <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />