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oPa"'"•. SAN JOAQUIN COUNTY <br /> P. ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c... P. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> 4Cl FUM1N <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddress: ity: iqVAW47M Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: - — ProgramRecord: 1J Inspection Type: <br /> Set 80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: aj'g4a U1012, ; <br /> 2, <br /> „ OBSERVATIONS AND CORRECTIVE ACTIONS <br /> _� VI <br /> 11;U I <br /> i <br /> e <br /> rw� . <br /> r <br /> a r4k 444 �j <br /> Pa " -�-i -'Ji / jt <br /> r <br /> O <br /> 1 1 444 t r <br /> l <br /> perat re° m/Lo o ...?• I Temmm. <br /> 'I,_ Certification= Facility Hot Water Temperature Warewashing' <br /> Name: Hand Sink: 0 0 of Chlorine: ppm Heat: eF <br /> Exp.Date: arewashing Sink: 61of Ouat.Amm.: ppm th 'F <br /> er: <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page Of <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />