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SAN JOAQUIN COON <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. a Telephone: (209)468-3420 Fax: (209)464-0138 Web:vvww.sigov.org/ehd <br /> LI�ifRi�; <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t Il E7S+V MOVICP Date: I U IG, <br /> Address: 01OF, <br /> Pat City: 5_bCAL�+(M Zip Code:ct 59-0 <br /> Owner/Operator: t- n b , n f)WSITD Telephone: As1 _T ') <br /> Program Element: Program Record: Gc3�_ Inspection Type: b rr ''T <br /> 8180 Posted D Yes O Permit Posted D Yes 01 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I SVM U Q uce i S Izjr I re CSt1 TV <br /> sizrr e a Ff -tto. <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: `Fhlorine: Ppm Heat: 'F <br /> Exp.Date: arewashing Sink: 'F Quat.Amm.: ppm ther: `F <br /> Received By/Title: s _! <br /> 7� f C 0 <br /> EH Specialist: Phone: _ /L(0 _ 2)G f <br /> Time in: G : 1 I 7 L Time Out: "1 Page of <br /> EHD 16-24 (1"pg) 4/3113 V FOOD PROGRAM OIR CONTINUATION <br />