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oRA�"+•. SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.orD/ehd <br />,cicoNt' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 7 <br />Date: Z <br />ddress: O <br />City: Zip Code: C / <br />J <br />Owner/Operator: AdWW <br />Telephone: <br />Program Element: Program Record: D Inspection Type: {0 e -4 n <br />r— <br />SB180 Posted Yes No Permit <br />Posted Yes No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Ort c <br />IVl r / C4 ly%Gle <br />- <br />�,� <br />'12AtK <br />4a., <br />-M Co I/e wv'�* <br />1 a <br />pt el 4 <br />D M tL <br />i Pi 9aV 4,y/sir <br />a�S <br />ho � tK � <br />a <br />f <br />COi�/ C <br />e � <br />OD <br />— Dbs <br />7 <br />✓e r` <br />✓� <br />p -_ / _ Tem"' _ <br />/ � i -,,-�1 `L �i 1 �2 <br />ure <br />F <br />SIF s <br />_ Food Safety Certification <br />Facility Hot Water Temperature <br />Hand Sink: of <br />Warewashing'' <br />hlorine: ppm Heat: <br />�Quat. <br />of <br />Name: IVI L4 h 0, n, A <br />Exp. Date: ^ I U n <br />�Title: <br />arewashing Sink: o f <br />Amm.: pPm <br />Other: <br />of <br />Received By/ <br />D/ �L S <br />� W� u A14'A11'1 • l D— <br />H Specialist: - � A <br />Phone: o r 3 O <br />1e <br />[me In: 0' -It <br />Time Out: r�, ' Op <br />Page of 27 <br />EHD 16-24 (2m pg) 4013 FOOD PROGRAM OR CONTINUATION <br />