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oP" .00` SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 40 t..) � V. A Rn n,) Date: <br /> Address: [,-7,O , City: C Zip Code: <br /> Owner/Operator: SIA <br /> V Telephone: '?65_0q30 <br /> Program Element: I Program Record: R G S O Inspection Type: 1270 U Tl Js n_� <br /> SBI80 Posted Yes Qol Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G) n m +h <br /> -b <br /> re i ►2 - <br /> m t+r 46 Y78:15�%.m� 6L+ 5n , c o <br /> n r L!rta 6 <br /> rL04nsl S - <br /> t !!G , '-1c, 0 Y, !:fn III- <br /> s h;t <br /> not <br /> e- r <br /> rs <br /> i an q arm <br /> Item/Location Temperature Item i Location Temperature' <br /> Food Safety Cert:flcation Facility Hat Water Temperature Warewasning <br /> Name: Hand Sink: 131 of Chlorine: Ppm Heat: F.,. <br /> Exp. Date: arewashing Sink: 131 eF uat,Amm,: boppm ther: of <br /> I <br /> eceived By/Title: <br /> , <br /> H Specialist: Phone: <br /> ime in: Time Out: 1• .��0 :Peg2e <br /> EHD 16-24 (2"pg) 4/3113 FOOD PROGRAM OF CONTINUATION <br />