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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0522240
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COMPLIANCE INFO
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Entry Properties
Last modified
11/19/2020 2:07:56 PM
Creation date
5/7/2019 9:33:36 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0522240
PE
1633
FACILITY_ID
FA0015151
FACILITY_NAME
BLACKWATER ON WHEELS #4GA6786
STREET_NUMBER
912
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
CURRENT_STATUS
02
SITE_LOCATION
912 YOSEMITE AVE
P_LOCATION
01
QC Status
Approved
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SJGOV\jcastaneda
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EHD - Public
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SAN JOAQUIN COON .,, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.., r p Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.siclov.org/ehd <br /> ,citl A"a?: <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V -I. Date: _ <br /> Address: 7)--7 S Zip Code: S_G <br /> Owner/Operator: Y Telephone: <br /> Program Element: 0 Z Program Record: S R 60 76010 Inspection Type:CO , ; <br /> 8180 Posted 0 Yes 0 Remit Posted ❑Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L: y G A6 lir 6 <br /> I) Prvvi de kc,o d rYly A6 pr J: f Jc tr 6o d a) <br /> 2 e r it; de s norne 0 A Or%f, S n cr <br /> I C in <br /> (.; lor Is yd 's <br /> to ft r a c r r4a 1/ CGf Ic"Icy <br /> 0. rt to ej 111P I'C n <br /> 3 <br /> Item/Location Temperature Item/Location Temperature <br /> S4eA014AhIt 60T 46 'r- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: IS �/ "F Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: 7 eF Ouat.Amm.: ppm Other: eF <br /> Received By/Title:17 7 <br /> 7— <br /> EH Specialist: \' _ Phone: t7 C/ lam, <br /> 14 <br /> Time in: Time Out: •7 Page of <br /> EHD 16-24 (2-Pg) 40113 J FOOD PROGRAM OIR CONTINUATION <br />
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