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aP4"'"•. SAN JOAQUIN COUNTY <br />? ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�••.. ;a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />+yi1dN� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: GC -L4 1 (.Z", 4;t-' y (�1 <br />Date: <br />Address: 2- Z51 CF, M ct tvt S (- . City: <br />45G�--AZip Code: <br />Owner/Operator: d.� 1CV 6 G U e '-r- <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />i <br />SBI80 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />- _ - SERVATIONS AND CORRECTW ACTIONS <br />a F16t�'vLri <br />f 20Z yes �re <br />Item/Location Temperature <br />T e- -2 ti <br />n, f -G- 6 <br />Facility Hot Water Temperature <br />Name: A0<L ri O G 4Crrero Hand Sink: <br />Item / Location Temperature <br />_ rewashing <br />'F Chlorine: I b ppm Heat: 'F <br />Exp. Date: <br />arewashing Sink: J <br />'F <br />oust. Amm.: ppm Other 'F <br />Received By/ Title: f . •i1� t/(') i / d <br />EH Specialist: �- <br />Phone: 2 16 ,- 3 o7c7 <br />Time in: : �a <br />Time Out: rl Page20f <br />EHD 16-24 (2o0 pg) 4013 FOOD PROGRAM OR CONTINUATION <br />