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p ,2 0 su e C1 (,- z <br /> OpgP.IN SAN JOAQUIN COUNTY <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Gs A. S 2 b'S Date: I — 12- <br /> ddress: \-}\ City: Zip Code: c� S2_0 <br /> Owner/Operator: ID CC7-4 + \ Telephone: <br /> Program Element: \ G Program Record: Inspection Type: <br /> SB180 Posted Yes No J Permit Posted Yes No Re-Inspection on or After: <br /> ISERVATIONS'A <br /> 2 - cLR.:. ch <br /> SZbS 2 <br /> Q e6 <br /> Vo�k <br /> d�e <br /> e <br /> s <br /> Oce - -1-1y - q - 22 �Z <br /> - - - <br /> Item/Location- - ' Item/Location Temperature <br /> UQQ <br /> `IIIty..Hot,Water.Tempereture _ W�:4� <br /> hing <br /> Name: J l\ Hand Sink: `o� of Chlorine: eat: 'FExp,De e: L0 arewashing Sink ) c oOuat.Amm.: POther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: 2-� V C2_ l 1_ — 3S <br /> Time in: f6 + S Time Out: GCt n G f\O_ Vim-Pagel of <br /> EHD 16-24(2n°pg) 41313 FOOD PROGRAM OIR CONTINUATION <br />