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SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT 10- t -
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<br />N__..:" _ -z Name of Facility: 'c3 GL.,....4 . -F-e, 1 \---t ) 1, A \ - \ 1 ( Date: .5 2 --/ _ -2
<br />Address: City: Zip Code:
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<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
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<br />Item/Location, Temperature Item / Location LTemperature
<br />Food Safety Certification Facility Hot Water Temperature Warewashing 4.11.111.11
<br />Name: Hand Sink: cf Chlorine: ppm Heat:
<br />Exp. Date: Warewashing Sink: . Quat. Amm.: ppm Other: °F
<br />Received By / Title:
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<br />EH Specialist Phone:
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<br />Time in: Time Out:
<br />(3 '1SC-A
<br />Page,.3f
<br />EHD 16-24 (2^d pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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