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SAN JOAQUIN COUNTY <br />?a ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.orD/ehd <br />4Fdtt <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />� / <br />(� y <br />/ GG Y(7 <br />Date: t �3 <br />Address: 2 2.'3 <br />2 <br />City: <br />Zip Code: <br />Owner/Operator: <br />6Telephone: <br />Program Element: <br />/ 2 <br />Progr mRecord: <br />P <br />O s-3 _J 2 <br />D J <br />Inspection Type:, �1 <br />B180 Posted Yes <br />No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />I <br />C RRECTIVE TION <br />4 <br />1 <br />�6rzr <br />eujjFP*S <br />S <br />p �� <br />Watttt t <br />it <br />--tura - <br />( <br />O C <br />10Q F <br />`-`� ✓ LoaK 4' <br />G <br />Name: <br />V'e/ <br />Q' <br />- Facility Hot Water Temperatu <br />Hand Sink: /2•J =F <br />/ <br />ewashing: <br />hlorine: - PPM Heat: aF <br />Exp. Date: <br />arewashing Sink: <br />13q'F <br />/ <br />her: o f <br />uat. Amm.: WD PPM r <br />Received By / Title: <br />Vaul <br />Q O <br />EH Specialist: <br />� <br />Phone: 616 '305 -2 - <br />rime in: <br />/0, <br />O <br />Page of <br />Time Out: / 12�M <br />EHD 16-24 (2 -pg) 4/W13 FOOD PROGRAM OIR CONTINUATION <br />