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oP4Hi". SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4vF;a+a. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date 1 a <br /> ddress: f�r` ry1 n ,i Clty: Zip Code: Q/• <br /> Owner/Operator: W1, g-T 4y'�yi' n Telephone:�/y�_ K <br /> Program Element: I 1'' '' <br /> Program Telephone: <br /> FIb lv. Inspection Type:�P. c- l <br /> 8780 Posted Yes No Permit Posted Yes No VG Re-Inspection on or After: �1 r <br /> OBSERVATIONS AND)COA ECTIVE ACTIONS <br /> Yn � - ii i1 I III I - Ahdb <br /> W tGtCe <br /> b �S <br /> CUI <br /> ►uS ix1h Aell S - <br /> S <br /> t -flat <br /> __IV_f_ <br /> 5'oa a was e C� n (iF s n n <br /> n ns se <br /> � - � pcitn u.n t Uri t o bU�m. a e i n <br /> Piano is rlk, a Ra eLS <br /> Uhliiln e2, *PWS ' L <br /> V ons ah ww's. V'6 o 9 VM01r� <br /> '-1t perature' - •empereture <br /> Food Safety Certification-, I FaciBty Hot Water Temperature <br /> rame* <br /> Hand Sink: eF Chlorine: PPm eat: °F <br /> p. Date: arewashing Sink: =p Ouat.Amm.: PPm ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> !me in: V Time Out: V 41 �m Page3of <br /> EHD 16-24(T°pg) 413(13 FOOD PROGRAM OIR CONTINUATION <br />