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i <br /> PgWrq..C' SAN JOAQUIN COUNTY <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.ora/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: N-RDate: I l-Z 19 <br /> Address: vs%U� W- City: Zip Code: S <br /> A/�� <br /> Owner/Operator: Telephone: 111;W5- <br /> �� <br /> Program Element: /'�Program Record: Inspection Type: r <br /> SB180 Posted Yeso o Permit Posted Yes Re-Inspection on or After: t <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ol-Nwn �, CGw1 - - <br /> 1 v <br /> CWV*k -t Ov I't <br /> (In <br /> � u <br /> wyt <br /> a ` <br /> 4N <br /> Item/Location Temperature Item 1 Location Temperature <br /> 3SQL - <br /> Food Safety Certification L__a_ndnk: <br /> lity Hot Water Temperature Warewashing <br /> Name: of Chlorine: ppmHeat: of <br /> Exp.Date: shinq Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> Time in: Time <br /> UQ avh Time Out: ":y Z Pagelof <br /> EHD 16-24 (2°1 pg) 4131`13 FOOD PROGRAM OIR CONTINUATION <br />