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A191-Q"!" SAN .10AQUIN COUNT <br /> � cGG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> cq.. NSP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �' 4v- _ 1), Date: <br /> Address: VL City: v1 Zip Code: <br /> Owner/Opera or: Y_V4(,-1j,64,7 V Telephone: <br /> Program Element: Program Record: D IAC Inspection Type: <br /> SB180 Posted i Yes No Permit Posted Yes ❑ No Re-Inspection on or After: <br /> ry OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L - !� J — c r <br /> _N ` , , <br /> vt kil(_ `hk `u,- 114 <br /> 4Mik7giv Ilo j- jj an W V11(?7 <br /> n k ar104 L'✓ <br /> C4,04aaa- 001 KI wild n <br /> Lj <br /> �-e <br /> Item/Location Tem erature Item!Location Temperature Item/Location Temperature <br /> I Glti C wa_ Gi( c Gi' r'� i _ 6 i� <br /> I44 <br /> C PX <br /> 7JCtit r Jk'f- ; U 6 / "-n v n fN <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: VII�lCelshing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: !ten Phone: _ <br /> Time in: V Time Out: Page of <br /> EHD 16-24 (2nd pg) 11/2/09 FOOD PROGRAM OF CONTINUATION <br />