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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c{ ...-.;.a Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd <br /> �IFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' Date: �7 <br /> Address: 1531 JklAlIV City: Zip Code: <br /> OwnerlOperator: 009 <br /> Vj ' S Telephone: <br /> Program Element: IProgram Record: Inspection Type: W(moi" <br /> 6180 Posted ❑Yes ❑ Permit Posted O Yes 0 1 Re-Inspection on or After: <br /> O¢SERVATIDNS AND CORRECTIVE ACT[ NS <br /> m- y <br /> ✓✓� <br /> I <br /> P 0 ' <br /> I 011n U e <br /> L ✓ ' G h <br /> VA <br /> (V- C f <br /> 'L <br /> sc Uo — by <br /> TB ... `. n Item/Location Temperature.. <br /> C <br /> Food Safety CertificationFaciirty Hot Water Tem Warewashing <br /> Name: 'Hand Sink: `F Chlorine: ppm Heat: eF <br /> Exp.Date: Warewashing Sink: - of uat.Amm.: ppm Other: of <br /> Received By I Title: Ve6f%n 5 <br /> EH Specialist: Phone: <br /> l <br /> Time in: I Time Out: 7lET Page of <br /> EHD 16-24(2A4 pg) Q113 V FOOD PROGRAM OR CONTINUATION <br />