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° SAN JOAQUIN COUN_ . <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4�leaaap. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: G o I Date: - 1 /s <br /> Address: 2V/ Z G as <br /> y City. S4 x n Zip Code: 9 S 1 c_r <br /> Owner/Operator: L e s 4 p r- 0 u)e n J Telephone: S G,q _ <br /> Program Element: 'b 0 _� Program Record: $ R 00 7 2-17 7 Inspection Type: <br /> Const+ IJal;r„ <br /> 8180 Posted 0 Yes 0 Rermit Posted 0 Yes 01 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L: c +r 0 q 133 Uj <br /> IIa1 11 C T A S,jF ,,,11 "� <br /> (01• i S0 i $ e f E ; Or )ou/ `1 I <br /> 00 !ser Ariod MAne, t e / CIa35 FAX <br /> Cef41f; tak ; n 619 dAy S . <br /> PrO viole q S e 14S W A r 01 i AcAe5he 4 wee <br /> 0(ea ;nbOArd a m stnK, LOrrre in <br /> 2 We e 1! <br /> rovrde" <br /> Sc rile ns i f W; ,.daLos it): I1 be o Fn <br /> COn >I'1110- C1 01 le � r srrrl' Serve 1;Cens <br /> a le IOr1S TI`C Ia A) re i ; as / 1011S <br /> 0 . II° ns ;s nc / <br /> adopvuje ltir n A CA e <br /> I re JO. V ; <br /> ra n 13 aln r Cl MfL it Th lAw ri1A s <br /> o ' n Onl ly 1p ) q (-C lr lrr, 5 5 dr6 ; c4 <br /> l r0jQfY tA SO ccn On 1 he <br /> re r <br /> �. C/ m." 1 or ? C LS <br /> GS le 401, r r/ <br /> ItemlLocatio Temperature Item I Location Temperature <br /> aNei <br /> Food Safety Certification Facility Hot Water Temperature, Warewashing,0,. <br /> Name: and Sink: "F hlorine: ppm at: "F <br /> Exp.Date: arewashing Sink: /12 `F uat.Amm.: ppm ther: "F <br /> Received By I Title: �..� <br /> H Specialist: Phone: / L•3�� <br /> Time in: F.,O Time Out: /!off G d Page of/ <br /> EHD 16-24 (2"Pg) 03113 FOOD PROGRAM OIR CONTINUATION <br />