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P4HI" SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />d�Gikd"a ;i Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: �H'A {Z- tQ. WA <br />-V4D ANG <br />Date: () 1 <br />05 -a <br />ddress <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />6180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />t os -t- <br />P t WtiS fY <br />r► S 'K-S1'aR-G' ANP <br />CO R ILGG i +17.0 A • <br />b t <br />llAf4tNMQid <br />T s R <br />K' <br />_ <br />Item / Location - - - <br />- CjDkj <br />_ <br />41f <br />1140LIc, CA <br />Dl.$efj4sl� fJis <br />Li, <br />W-0 t- n 04 P-0 L-L-je . <br />MMNjjEVpcj Certifleation _ - <br />Name: R AV ff`id�R- SIIN <br />1-63 V <br />Facility Hot Water Temperature <br />Hand Sink: ' �0 <br />'F Chlorine: PPM Heat: <br />-F <br />Exp. Date: <br />arewashing Sink: 1 20 <br />-F <br />oust. Amm.: ppm ther: <br />of <br />Received By / Title: <br />EH Specialist: C L A U D I A- ✓ 4 <br />Phone' <br />Time In: 90 <br />� <br />Time Out: ! Z: s'Al <br />Page2.ofZ. <br />EHD 1644 (2n Pg) V3/13 FOOD PROGRAM OIR CONTINUATION <br />