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SAN JOAQUIN COI,._ .Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> CIF'O'Rt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ✓ \ Gc�3 ICY S si -tz�c� Date: Ic ,1� <br /> Address: City:LJ C Zip Code: <br /> Owner/Operator: h <br /> l <br /> Teepone: <br /> Program Element: � 2Program Record: O 056 <br /> �h 3 1 Inspection Type: -F7i <br /> SB180 Posted Yes No Permit Posted - Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> JI W C 4C r /o �O p r kL-I i hC 110 <br /> v d 'c 't' -e '� t- <br /> u r L <br /> e- o Pe 4ac, rn !a <br /> Ut LA.A*i .,'nLr 116enaa r c. <br /> ,P—V k-a 40 r a l ton c U --k i -kr 6, Q_ttC C- <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> � <br /> Lo �r dA G cf vt /`r - Location- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: r i . Hand Sink: " 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: / are shing Si k: Ouat.Amm.: other <br /> /' r� 1- �� f �F ppm F <br /> Received By/Title: <br /> EH Specialist: Phone: -22 <br /> Time in: 1 .00 <br /> Time Out: : 35 <br /> 3 Page of / <br /> EHD 16-24 (2nd pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />