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SAN JOAQUIN COPY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: a <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> cq., ap Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> cippii <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 40,00vli:l Date: <br /> Address: em <br /> PV City: Zip Code: <br /> Owner/Operator: /v n Telephone: <br /> Program Element: /i Program Record: /i D Inspection Type: <br /> SB100 Posted Yes ❑ No Permit Posted P <br /> s C No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Zc ✓ Ad124#U1 /IG�/c r -csG ✓ `rn o)yc 4. <br /> to v -- <br /> ✓ RG G <br /> o c �t�e rn v r� <br /> - ✓tel SS ' e✓ % <br /> v J WG!✓►YICr— tJ �aD <br /> 00 < AtIor —' <br /> � r <br /> Item/ ovation „- Temperature Item/Location Temperature <br /> U' c 31 5 ` F - - I <br /> Y 1t o G l/?n 2 ° <br /> S 3 G ah ACR&P, hkn,le 1 <br /> Foo ySafety Certification Facility Hot Water Temperature _ Warewashing <br /> Name: Hand Sink: -F Chlorine: ppm Heat: �F <br /> Exp.Date: arewashing Sink: 1d3 of Ouat.Amm.: PPM Other: 'F <br /> Received By/Title: <br /> oi� VA <br /> EH Specialist: Phone. -- <br /> ime in: V2Ifo <br /> If Time Out: Page9of <br /> EHD 1624 (2^pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />