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,g�4 ••sA� SAN JOAQUIN COUNTY <br /> aj ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4..,s, ,:;a Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> CIFd�� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 77-477 <br /> Address: p City: Zip Code: <br /> Owner/Operator: V es Telephone: [�✓ <br /> Program Element: Program Record: - qo Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ln't✓ _ <br /> S <br /> 0 <br /> k G <br /> S <br /> exit Wt o <br /> Cu it j�� <br /> 7-t1 z <br /> ItemlLocation Temperature Item I Location ' - ` Tarn peralure <br /> Food Safety Certification Facility H_ot.Water Temperature _ _ Warewashing <br /> Name: �HandInk' <br /> S 'F hlorine; ppm Heat: "F <br /> 11 <br /> Exp.Date: arewashing Sink: 'F uat Amm.: PPM IP ther: -F <br /> Received By I Title: 1 <br /> EH Specialist: l - Phone: •�I nl"Ii _ 6( _ -l" <br /> 7-0 <br /> ime In: Time Out: V U Page o6 <br /> EHD 16-24 (2d pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />