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opq"!(Y.'t, SAN JOAQUIN COL Y <br /> 'X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton 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 <br /> Name of Facility: G!�l►'l n r Date: I - _I _I <br /> Address: o U L- City: C Zip Code: <br /> Owner/Operator: v Telephone: 1916'6- <br /> 9,16'6_ 1100 <br /> Program Element: (0-Y)_ Program Record: (R OI(Da3 GSD Inspection Type: 1ZO� �- <br /> SB180 Posted a No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1- I F7a '±tj in <br /> I <br /> Item/Location t-) I'Tia mpe(ature '„ Ite, !!Location Tcm, atu-e <br /> Nfyrnrw ►� K-t +r )--e n <br /> UJA r rmt r , , - - 1060 <br /> --17"J,J.e, y`1q r,--e r " I <br /> Food Suf ty Certification Facility Hot Water Temperature Warewashing <br /> Name: ��' erYvuri t0.. 1 ��r� U (Hand Sink: I r� of Chlorine: ppm (Heat: of <br /> Exp.Date: arewashing Sink: (��/ of uat.Amm.: ppm !Other: of <br /> Received By/Titlp� L <br /> EH Specialist: Phone: <br /> Time in: I: 0 Time Out: PageZof2 <br /> EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />