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,gP4 .pA` SAN JOAQUIN COUNTY <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> d4�iadiiNUb Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� Date: ( — 1 ` <br /> Address: 15 , City: �`. 1.1 Zip Code: q 52 <br /> Owner/Operator: A V Telephone: <br /> v1 _2J-i <br /> Program Element: l bZy rogram Record: 2-7_ j0 f Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No T Re-Inspection on or After: <br /> AVATIO aC A TIVE ACTIO S <br /> b <br /> W <br /> n <br /> 02 <br /> l of d'Fo.G. \t e 0__\AS "+ t 11C G <br /> 011�lL�/� <br /> Item/l.oeation'• _ - - nature. <br /> l2� E_ i - =� 1-3 <br /> \ec\ e x=08 2 6L u _ <br /> 2 � <br /> \35— \ `11 - <br /> :ood Safety Certification -Facility Hot Water Temperature _ Warewashing n, <br /> Name: c ^ \Je d Sink: 1 OO aF Chlorine: PPM Heat: �F <br /> Exp.Date; ee arewashing Sink: \ of Ouat.Amm.: y ��PPm Other: oP <br /> Received By/Title: �.. <br /> EH Srecialist: - Phone: 2 0CA_ l_V `U 1 1__ <br /> ime in: Time Out: 1 e Page of <br /> EHD 1624 (2ntl pg) 4013 J FOOD PROGRAM OIR CONTINUATION <br />