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SAN JOAQUIN COU f: <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s6gov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: I <br />Address: <br />\ "rr�,1 <br />`a City: <br />MC)dn Zip Code: q�G <br />WL <br />Owner/Operator: <br />v Fi .tea <br />�C <br />Telephone: AOCA_(4 f �} <br />Program Element: <br />Program Record: <br />Inspection Type: v=�5`�L <br />SB180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />C1 M �i'i <br />UVR4M1r <br />Item/Location <br />- <br />Temperature <br />Item J Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />_ Warewashing <br />Name: <br />and Sink: <br />"F hlorine: PPM Heat: "F <br />Exp. Date: <br />arewashing Sink: <br />-F Ouat. Amm.: PPM ther: `F <br />Received By J Title: <br />EH Specialist: <br />QA <br />Phone: i. rail �. ra q) 734+ <br />d -{r <br />'CJ 9pagelf <br />ime in: it . hr(1 <br />Time Out: <_ <br />EHD 1624 )2n0 Pg) 4/Y13 FOOD PROGRAM OR CONTINUATION <br />