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°"'" 0 SAN JOAQUIN COUNTY <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s*gov.org/ehd <br /> <<FpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -v\ ���� Date: <br /> Address: \0 ; City: Zip Code: S�� <br /> Owner/Operator: Telephone: <br /> Program El refll-2 (OAC 5 Program Record:-53 \2 5 S ZZ Inspection Type: <br /> SB180 Posted �j ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: 4 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS . <br /> A-3 SV--t_j <br /> (2 YY1 <br /> S: l <br /> 3 2 CI <br /> 3 C—, — t <br /> \Z � 3 � <br /> cv�rp S C <br /> l� eQQ;� <br /> Item/Location Temperature Item f Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: �oF <br /> Exp.Dat Ware washing Sink: of Quat.Amm.: ppm Other: of <br /> Receive / itle: <br /> EH Specialist: Phone: �-kb(3 0� <br /> Time in: 5- Q—s Time Out: b, 0 Paget of <br /> EHD 16-24(2n1 pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />