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SAN JOAQUIN COUNT . <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. _ a;P.. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G - �� _ Date: 2- <br /> Address: \ City: 4 _ Zip Code: S 3 <br /> Owner/Operator: 6 n Telephone: <br /> Program Element: i a Program Record: �� be 2- Inspection Type: — <br /> SB180 Posted Yes\ No Permit Posted Yes No lJl� Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G <br /> C T <br /> vJ i013r - <br /> C_ geedSA 00 <br /> VIF <br /> L V�CD T 'L S� <br /> Item/Location Temperature - Item/Location emperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ------ ----- <br /> Name: Hand Sink: -F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: F Quat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Speciali C t-1 Phone: Q _ (C)I b_ _ 2� <br /> Time in: 7t Time Out: Page of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />