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r t <br /> oaul" o SAN JOAQUIN COUNTY <br /> 14 X ENVIRONMENTAL. HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.si-gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: § u (37. 7 4 107 567)� Date: / 14 <br /> 2� <br /> Address: AVS 0 M-P}'�E� City: v h ,,� Zip Code: 2 <br /> Owner/Operator: r. �1 C a- +(2.e l {W Y+V Telephone: r <br /> Program Element: t WG �l Program Record: C a()C)3 c6 j'5 Inspection Type:C()tA �-_(j nt- <br /> SB180 Posted Yes l No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ��1� IGttC1� S OJ) C-e' a(�' Sick Gkhd 1�C�nG way <br /> O� �k I e C <br /> �( "COU IV-V ONJ Unk w h a .` SICK c I)R a <br /> C� ord my Y to <br /> G v i m 1\cW I <br /> -AqtbItem/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: PPM eat: "F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: �( : U Time Out: - !, Page j of <br /> EHD 16-24 (2nd pg) 4rAf13 v FOOD PROGRAM OIR CO INTINUATfON <br />