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SAN JOAQUIN COUt a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • id.• •.` .. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.segov.org/ehd <br /> ;,Ob, <br /> s <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r C G I G{ •re it y Date: Z - <br /> ddress: N .n S � City: �+ ��CN Zip Code: [75 <br /> 3f, <br /> Owner/Operator: I G r Telephone: 1�/Q <br /> Program Element: l I Program ecord: GS Inspection Type: r 1 <br /> 6180 Posted Yes r- No Permit Posted Yes [ No Re-Inspection on or After: <br /> Vi 0 l is r rte`c fed'. -- <br /> - 4 Y* 51roc"i_ does _u6 'n k <br /> 1n h l n <br /> Or , de f <br /> Qx, !1 rn IVt UP , <br /> Rot) i! Jr 30 l <br /> lteanft ocat%on, Teirlp3ratur "em J Location Tem rature <br /> Farad Safe .G>rt ica# ►n aer itj�t#� Pltt:ter` �mperatttte ware <br /> Food <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F uat.Amm.: PPM Other: `F <br /> Received By 1 Title: <br /> EH Specialist: Phone: 4t <br /> ime in: 1 Time Out: �J 3 G Page of <br /> EHD 16-24 (2' pg) 413113 \' •C FOOD PROGRAM OIR CONTINUATION <br />