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SAN JOAQUIN COUNTY <br /> p' ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _._ 600 East Main Street, Stockton, CA 95202-3029 <br /> .. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> �P <br /> 9CicORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C h ,,� c 110 O Date: �Q _ <br /> Address: } S G G V C1 V City I rAe Zip Code: / <br /> ner/Operator: Telephone: X30 —3J <br /> Program Element: Program Record: Inspection Type: C V1 I n f <br /> SB180 Posted Yes No Permit Posted a Yes ONO Re-Inspection on or After: <br /> ONETIVE' <br /> I ra W& 11 C c r , r Ic , e.; r to or; <br /> 2 M oPe f s# c C 1C, WelS <br /> /(�� <br /> J fU `i h i00d of f <br /> J tvlCS <br /> Item/Location ; Temperature Item/Location <br /> � r 737 <br /> �(=acility Hoi Watei <br /> .. --- __..__... <br /> Name: and Sink: - �04- -F hlodne: ppm eat: "F <br /> Ge t , nC U-N0y <br /> Exp.Date: _ arewashing Sink: 'F rust.Amm.: . U ppm her: "F <br /> Received By/Title: <br /> H Specialist: P one: _ fx <br /> mein: Time Out: 0:2 Page of <br /> EHD 16-24 (2i°pg) 11/7/09 FOOD PROGRAM OR CONRNUATION <br />