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SAN JOAQUIN COUI. ,! <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> caci ka,P.. Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 1 .2- IS <br /> Name of Facility: S n G C i i 41 Pv4 DoS Date: A2 <br /> Address: 1717 S City: S+K Zip Code: 9 S 2C/C <br /> Owner/Operator: S 2 S 1 , r CA U Telephone: 8-0 k_ :7Y <br /> Program Element: (J Program Record: S O G lis Inspection Type: ✓1S u ; ,4 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> L ;c 1K AS r2 ' <br /> - J pr0V ; de 00nrt '5 Aar✓tc On ----boah - S ; o_/,"s_ o � <br /> )f C C (ArrrnLl( cct ree't in C <br /> c. er1 <br /> 0M F r t t 4 : 7 r: C o� i rl G -/-1 <br /> , la ermoA te. Los be"n ;01. <br /> 5= <br /> 0o fet rti IZatron � aclii `` T 1 `ter em' r&tUr`e � _ .Warewasfiin'g,�. �� - <br /> ..�, <br /> Name: Hand Sink: G 'F Chlorine: PPM Heat: "F <br /> Exp.Date: Warewashing Sink: -F Ouat.Amm.: PPM Other: 'F <br /> Received By l Title: VW <br /> EH Specialist: Phone: <br /> Time in: ff Time Out: I Page of <br /> EHD 16-24 (2n°pg) 41Y13 FOOD PROGRAM CIA CONTINUATION <br />