Laserfiche WebLink
aP441 N•.c SAN JOAQUIN COUNTY <br />r' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />..c4ciFo'n`'�P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.orDlehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: M <br />5 <br />V 5 Date: <br />I _ I —r _ �3 <br />Address: 2 1 12 ,/fin City: <br />t <br />S Zip Code: <br />of '5205 <br />Owner/Operator:1 <br />S n SU t <br />Telephone: <br />Program Element: , b �l J <br />_I <br />Program Re d: S 3 1 <br />Inspection Type: <br />Bt 80 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />UIN r r <br />=t b. e I <br />-21 -22 <br />Item Location <br />" Food Safety Certification <br />Name: <br />Exp. Date: <br />Temperature I� Item / Loc tion <br />_ Facility Hot Water Temperature Warewashing <br />Hand Sink:of Chlorine: ppm IIIHeat <br />WarewashingSink: of Ouat.Amm.: Ppm IlOther: <br />Temperature <br />F <br />_-- - -- 'F <br />Received By/Title: <br />EH Specialist- <br />- <br />Phone: <br />Time in: (6 C-'rn <br />Time Out: f1 r S 1 <br />Pag f <br />EHD 16-24 (2•^ P9) 4013 FOOD PROGRAM OR CONTINUATION <br />