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a4t`n' Pq` SAN JOAQUIN COUI,.W <br /> q ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s6gov.org/ehd <br /> Uad'A <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �• PWG - 2 bO( Date: <br /> ddress: I3,lJI i,1. Ir Il _� City: Zip Code: <br /> wner/Operator: W Telephone: <br /> Program Element: Program Record: Inspection Type: n <br /> B180 Posted a Yes a No Permit Posted Yes -- No Re-Inspection on or After: <br /> S AND CORRECTIVE ACTION& 'x •= <br /> Sid <br /> Moe cl oor OJ dispi.7 an1pr)kcilo S.11ad d,60214 <br /> n q uk <br /> Pc I O del <br /> b u <br /> 7 <br /> afety Certification Facility Hot Water Temperature Warewashing , ,•_: <br /> Name: Hand Sink: `F Chlorine: ppm Heat =F <br /> Exp.Dale: Warewashing Sink: 'F Ouat. Amm.: ppm Other: of <br /> Received By/Title: - <br /> EH Specialist: Phone: -3'�6 <br /> ime in: Time Out: Page of <br /> EHD 16-24 (2^pg)4/3/13 FOOD PROGRAM OR CONTINUATION <br />