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Pq"!N SAN JOAQUIN COL -Y <br /> . � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> �1FOR`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: " 02 <br /> vz— Date: <br /> Address: rkL L,,-x City: Zip Code: <br /> Owner/Operator: M1141 <br /> Telephone: — 27 <br /> Program Elemen : Progratn Record: ! 2� Inspection Type: <br /> SB180 Posted Yes ❑ No Permit Poste Yes No Re-Inspection on or After: <br /> . t <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: VVI/��1 ��� Hand Sinkz: of Chlorine: ppm Heat: of <br /> Exp.Date: !/� arewashing Sink: '2.2 of Ouat.Amm.: ppm Other: of <br /> Received By/Title. 11 !' <br /> EH Specialist: I Phone: <br /> Time in: Time Out: o•� Page of <br /> EHD 16-24 (2n°pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />