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qu� SAN JOAQUIN COUNTY <br />�. <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-623 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sicjov,org/ehd <br />4tlFOR� <br />n! --r% nr%r%^nAn)1 rlrrl(--IAI IN_qPECT10N REPORT <br />rvvu r %01 1 <br />Date: W/ <br />Name of facility: , G\\ -A&A -4,2 -A&A -4,2Q <br />A City: Zip Code: <br />f+ <br />dress: <br />Address- <br />Telephone: e U„eb},b4j62_ <br />Owner/Opera <br />OwnerlOperaior: n U SU <br />Inspection Type:: f 1s►+ <br />Program Element: Program Record: <br />B180 Posted Yes No Permit Posted Yes No die -Inspection on or After: <br />. <br />F_�7_ <br />- <br />Cc�M� CardU Ck Pew CAN <br />: � �: <br />Fwd 5af.. i icat li ;::` . a(a .. ft<r Te ...:..: itr ,: are Shing <br />Name: Hand Sink: `F Chlorine: ppm Heat: 'F <br />Exp. Date: Warewashing Sink: 'F uat. Amm.: ppm Other: 'F <br />Received By ! Title: <br />EH Specialist: Phone: 6 2 <br />�] <br />Time in: 2: Time Out: Page of <br />EHD 16-24 (2� pg) 413113 FOOD PROGRAM OiR CONTINUATION <br />