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SAN JOAQUIN COUN1^f' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ... m a Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> 9C%FOM1� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O Date: D 8 - 1:3 <br /> - <br /> ddress: oll !' City: Zip Code: <br /> Owner/Operator: VV J Telephone: <br /> Program Element i5 Program Record: Inspection Type: fv"4-j'ne <br /> B180 Posted .Yes L No V Permit Posted es ❑ NoJ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> OFcocj 5rc c + n o <br /> C Fr)5jWCPa4 <br /> tY00 /'VIS - <br /> hd <br /> Item/Location Temperature Item I Location Temperature Item I Location Temperature <br /> F r.dge LtC'F - -- - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: a 11- Hand Sink: p of Chlorine: pPm Heat of <br /> Exp.Date: 03 , d 9 _ (l ,rewashing Sink: D >pDust Amm.: ppm- Other: - 'F <br /> Received By I Title: J <br /> EH Specialist: V Phone: <br /> ime in: Time Out: f s Page of <br /> .S4 /V1 <br /> EHD 16-24 (2n°pg) 419112 FOOD PROGRAM OIR CONTINUATION <br />