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SAN JOAQUIN COUNT. <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4�jFaRia <br /> �P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G77o , Date: <br /> ddress:,Z,^l:bC 1 S (� City: 1l � Zip Code: S <br /> Owner/Operator: f J \ ZJ� Telephone: ,Z I — to 13 <br /> Program Element: Program Record: ` t ' 1 Inspection Type: <br /> B180 Posted ❑Yes ❑ Permit Posted ❑Yes n I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CA C11 0 <br /> - <br /> � <br /> c <br /> AIA 5 e <br /> vie <br /> v —�) <br /> ­1 CQ 21 e 1 I <br /> Food Safety Certification my' ii�y ,I Facility Hot Water Temperature Warewashing <br /> Name: _.w. . Hand Sink: v of Chlorine: -- ppm Neat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> Reg% 0.n <br /> ed By/Title: ' <br /> \.� � - <br /> EH Specialist: 1 _ Phone: <br /> ime in: 1 1 <br /> ?_75 <br /> �1 Time Out: .-1 Z Page lof ' <br /> t C-EHD 16-24 (2,dpg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />