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SAN JOAQUIN COUNTY <br /> 2` z ENVIRONMENTAL HEALTH DEPARTMENT <br /> W a X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �.., ;P.. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �lFOR� o <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: y ! ,. Date: t'ell(211.z <br /> Address: ,1 City: f; Zip Code: / r• <br /> Owner/Operator: V (�y Vii ! 'Telephone: <br /> Program Element: Program Record: Inspection Type: N 40 <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> y ' OBSERVATIONS AND CORRECTIVE ACTIONS ' <br /> ° lWL <br /> IN <br /> J1 08 34 <br /> v fj <br /> f <br /> Item/Location Temperature ? Items%Location "Tyemp Lure " Item/Location `Temperature <br /> Food Safety',Certification Facility Hot WaterTemperature 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 /> EH Specialist: Phone: 0-3 <br /> Time in: Time Out: V J Pagel of I <br /> EHD 16-24(211 pg) 4/9112 FOOD PROGRAM OIR CONTINUATION <br />