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PQ"'" 0 SAN JOAQUIN COUR <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: •< X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: WD u W � Date: �1 13 <br /> ddress: 'jj l C` CAI 1{"V h� G � City: 1"10�`� Zip Code: Ci <br /> Owner/Operator: ?on ve Telephone: <br /> Program Element: Program Record: PR 0 53 Ct U Inspection Type: <br /> 6180 Posted Yes ❑ Permit Posted ( Yes ❑ 1 Re-Inspection on or After: �- <br /> OBSERVATIONS J?C. RRECTIVE ACTIONS <br /> 9WW i S Se11`Oh A I V- Read/ tv- .QUfi ft 06S . 11 cC CM b <br /> A-pd CSJJJ 1 whale u Le Dy-CA <br /> �vdS <br /> Item/Location Temperature item 1 Location Temperature <br /> Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat. of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm ,Other: of <br /> Received By/Title: <br /> I <br /> EH Specialist: Phone: <br /> Time in: I1 ; I Time Out: `�• Z(� l� 1r� Pig of I <br /> EHD 1624 (2n0 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />