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,al" 'na•�, SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• E��IPe��;;e Telephone: (209) 468-3420 Fax. (209)464-0138 Web: www.sigov.omlehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />✓ ki <br />/ % [�wtvLi <br />Date: 1 Z <br />2d <br />ddress: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Y Yv <br />Telephone: <br />Program Element: <br />adY <br />Program Record: {D )2 S G 1 —7 <br />1 a <br />Inspection Type: <br />SB180 Posted Yes <br />No Permit Posted Yes No <br />Re -inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />✓V1A. <br />oA- <br />Z.�� I <br />sztl <br />L <br />l <br />ItamlLocalio <br />'Temperature <br />Item I Location - <br />Temperature <br />Food Safety Certification <br />Facility,_Hot Water Temperature_. <br />Warewashing <br />_ <br />Name: <br />Hand Sink: <br />eF Chlorine: PPm <br />Heat: <br />of <br />Exp. Date: <br />Warewashing Sink: <br />of F,uat. Amm.: PPM <br />Other: <br />eF <br />Received By / Title: <br />EHSpecialist: <br />(/VEL <br />Phone: <br />ime in: 2 <br />Time Out: 2 •L <br />Page <br />of <br />EHD 16-24 (20 pW 413113 FOOD PROGRAM OR CONTINUATTON <br />