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SAN JOAQUIN COUN . <br /> �-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 4C]�oRe� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J� SA Date: \4 -1-1- I S <br /> Address: SZ k <br /> ' .n SA- City: Zip Code: q S 24 0 <br /> Owner/Operator: V-e 1 1 Bro")V-\ Telephone: 9_ q 3 I <br /> Program Element: 1 b 13 Program Record: S0CV L � 1 Inspection Type: l TO_I- �� <br /> 18 <br /> 60—Posted Yes ❑ PermitPosted es ElI Re-Inspection on or After: _ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> vL YL <br /> S <br /> i <br /> Z c� <br /> 2_0\-_),eacn C <br /> C � t � <br /> 3 . <br /> 5 5 CI — <br /> � b <br /> Itemil-ocation j Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: \ Hand Sink: ;1 of chlorine: ppm Heat: of <br /> Exp.Date: . 1 r ewashing Sink: i22 of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: b� O <br /> Time in: ; i O Time Out: `O ` 1 Page-of <br /> _1 <br /> EHD 16-24(2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />