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pPa�°' coa SAN JOAQUIN COUV' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s4gov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �,eAz` , (tDu- Ani Date: A/15/14 <br /> Address: G �" jmy '2b City: Vwaaf) Zip Code: Cl <br /> ` I <br /> Owner/Operator: rtLl 1 1_e4-+Z) l <br /> No\'( <br /> V Telephone: <br /> Program Element: i 1C/� �l Program Record: C coo-,Oh}� Inspection Type: <br /> S8180 Posted Yes 1 No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> c crn 6101t 6t&fes : W dOOV c aV'?" AMO K*vzom . tso ':� s <br /> kYL wGq(K\ <br /> doth r�- 0 S .2 \.Nctvm PJ+r- kzweA& . <br /> PW <br /> �o r S <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certif cation Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: 'F <br /> Exp.Date: 1 i,- Warewashing Sink: `F Quat.Amm.: ppm Other: of <br /> EReceivedBy/Tit e:list: Phone:Time Out: ;s Page of <br /> EHD 16-24 (2n,pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />