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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0527301
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COMPLIANCE INFO
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Entry Properties
Last modified
4/22/2020 1:57:30 PM
Creation date
3/21/2019 2:21:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0527301
PE
1628
FACILITY_ID
FA0018492
FACILITY_NAME
GOOD SAMARITAN REHAB & CARE
STREET_NUMBER
1630
Direction
N
STREET_NAME
EDISON
STREET_TYPE
ST
City
STOCKTON
Zip
95204
APN
13705001
CURRENT_STATUS
01
SITE_LOCATION
1630 N EDISON ST
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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°P4ulN' c SAN JOAQUIN COPY <br /> �.•'�••.off <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 600 East Main Street, Stockton, CA 95202-3029 <br /> �q..., NiP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> /FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ii:Ion MQ <br /> -+ r haul 4- Date: / _ <br /> Address: '(O 30 N >✓ Sp n City: c 0 C* Zip Code: pl 5� <br /> Owner/Operator: SiJ Telephone: q y _ <br /> Program Element: (P-Z'S <br /> Program Record: R 052-2 3 <br /> 5of O Inspection Type: R. <br /> SB180 Posted.*Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> io 92 61 <br /> r r2 - o L-S CRi <br /> I vt r rr �vP <br /> mOr2 -� <br /> i n Gu v G.2 _ r'o 02 Sr <br /> a IQst S r <br /> -5 <br /> hol wq4er hand - 'n s 6 <br /> Item/Location Temperature Item/Locat" n - Temperature Item 1 Location Temperature <br /> Yj <br /> , v c- 0 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _. _... <br /> Name. ( �1 Hand Sink: F_ Cfyron e: ��L�C� PPm H t / jv F <br /> // w Cs <br /> Exp.Date: ^� ar washing Sink: of at.A. E.# ZOb ppm Other: of <br /> Received By/Title: �R rLQ Ua� <br /> G'� �V' lJ <br /> EH Specialist: / Phone: <br /> � 2 i✓ <br /> Time In: C C� Time Out: Page_of 1 <br /> EHD 16-24 (200 pg) 11/2/09 FOOD PROGRAM 01R CONTINUATION <br />
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