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r <br /> SAN JOAQUIN COUN <br /> q ?< ENVIRONMENTAL HEALTH DEPARTMENT <br /> ` s 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> CIFdk� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: gu_ /70. Date: Zz. <br /> ddress: VU <br /> � SCM City: s-+t> <br /> w Zip Code: <br /> Owner/Operator: `vv Telephone: <br /> Program Element: Program Record: Inspection Type: J <br /> Q <br /> B180 Posted 0 Yes 0 Rermit Posted O Yes 0 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0 Z. <br /> O-Cu: <br /> ry <br /> ItemfLocation Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: 'F Chlorine: PPM Heat: "F <br /> Exp.Date: arewashing Sink: "F Quat.Amm.: PPM ther: 'F <br /> Received By I Title: 1 <br /> EH Specialist: � r— <br /> Time in: I t1 /p Time Out: �Tj Page cf <br /> EHD 1624(2-pg) 46113 _I J v r7 FOOD PROGRAM OR CONTINUATION <br />