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VAN.... SAN JOAQUIN COU4 <br /> :a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • - ;P. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov-or4lehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C G Date: - +V <br /> Address: 1�-'� City: inn Zip Code: cf 3� <br /> Owner/Operator: I S -cam Telephone: Q•�S, <br /> Program Element: Prograrh Record: �� +�� Inspection Type: <br /> B180 Posted ❑Yes ❑ Rermit Posted Yes ❑ 1 Re-Inspection on or After: <br /> �,_, <br /> � � � IDR# <br /> r.. �. _ <br /> �w Q..� ��. <br /> CA_QIAj_Q_14 AN <br /> P - <br /> 3 � <br /> _ 3 vK)b-vr� 0 `7 If= <br /> `A ' )I -F(ee 1 Z <br /> `--'I1 F <br /> Name: Hand Sink: 1 `F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: F Quat.Amm.: ppm Other: 'F <br /> Received By!Title: d <br /> EH Specialist: Phone: :-A <br /> 1012>—os <br /> Time in: .0Time Out: O��� Page of <br /> EHD 16-24 (211 pg) 4!3113 FOOD PROGRAM OR CONTINUATION <br />