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Qu,N SAN JOAQUIN COUIt <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web-www.S' ov.or lehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: tjl2-41 I� <br /> FNameofFacility-. av G`� V Q�111A� 1 t"HCity: C�;CJK 'T) Zip Code: gc32U2 <br /> ess: 25U �- <br /> Telephone: ��er/Operator: \ , `?Gv U I t <br /> Program Record: �'i (y Inspection Type: �J� ..1 C1S �C, 1 GTl <br /> Program Element: 1 L� 9 <br /> B180 Posted .:Yes No Permit Posted Yes I No <br /> Re-Inspection on or After: <br /> t40 >;,•le cor,w a 0 n -mom arm <br /> Iterr�.� on ,. ;.. .. _,. Ternpe�atuire 9ferrr J lb,wativn der» ._ra'tiere <br /> Pored safety C rtificatEo ; .,; °:F G1iLty lout Wates a afure Warexvas#tltag <br /> Name: l . Hand Sink: eF Chlorine: Ppm Heat: °F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm ther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: qcq <br /> Time in: 1 U - " Time Out: lU�m Page of <br /> EHD 1&24 {2w pg}41afl3 FOOD PROGRAM 0IR CONTINUAT#ON <br />