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am" SAN JOAQUIN COUt <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> �q. <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 117 7 777 77 <br /> G. 477,27e Date: -7777/7 <br /> Address: j ` City: Zip Code: <br /> Owner/Operator: 1 V n y Telephone: <br /> Program Element: /e Program Recor "��--�J ?, � Inspection Type• <br /> SB180 Posted Yes GC No Permit Posted Yes Nov v Re-Inspection on or After: <br /> � _ G'fJGIG r�lJzc C 'orA-" <br /> � u <br /> blot <br /> Gt' J' �f d1-r J'� �✓ r <br /> Pkl 71 1 tit— &reaa rlp 5 <br /> u� [P. • <br /> P-711 iY-Z <br /> nto Ci <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: -(JAL Phone: <br /> Time in: t Time Out: c� Page/of/ <br /> EHD 16-24 (2W Pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />