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SAN JOAQUIN COUP' <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orq/ehd <br /> �iFo'Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1� 1� 1� Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> M & W Dutch American Bakery - - <br /> 4343 Pacific Avenue -- <br /> Stockton, CA 95207 - - <br /> (209) 473-3828 <br /> C'o� <br /> - ('Wdutchamericanba'1'e'CS — <br /> -Y CUMQ, to -WD C1 'SW we+ V_fd_0T _err m i r <br /> Item/Location I Temperature Item 1 Location a_ eiri ature <br /> Food Safety Certification Facility Hot Water Temperature �.:; .A._ 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: 2Gry 6 L} I <br /> Time in: rN .k) Time Out: 1 V Page Of j <br /> EHD 16-24 (god pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />