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°WN SAN JOAQUIN COUN <br />z� ENVIRONMENTAL HEALTH DEPARTMENT <br />_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• ... iP • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />9GjFp'�e <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:? <br />Date: 4711,11 <br />dress:`^ <br />Address:—,-A <br />/ <br />V <br />A City: <br />Zip Code: <br />Owner/Operator: <br />"•- `nex <br />Telephone: <br />Program Element: <br />Program Record: D(;D' <br />Inspection Type: <br />8180 Posted <br />Yes ❑ Rermit Posted Yes ❑ 1 Re -Inspection on or After: <br />�{{ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />_,•." IIY�WY <br />7; <br />r# <br />Temperature <br />of ,s -:1-) <br />419 <br />47 r- <br />Food Safety Certification <br />Name: <br />Exp. Date: <br />Facility Hot Water Temperature <br />Hand Sink: of Chlorine: <br />arewashing Sink: f i of Quat. Amm.: <br />Warewashing <br />ppm Heat: <br />ppm other: <br />of <br />of <br />Received By / Title: <br />EH Specialist:; <br />_ { <br />Phone: <br />ime in: <br />Time Out: <br />Page of <br />EHD 16-24 (2otl pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />