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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> n'vasaY,... Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 110 W 00 V.. den 97O 0 S Y t Date: R . 30 -O y <br /> Address: W. o W G city: S } K h Zip Code: 9 S 2615 <br /> Owner/Operator: Telephone: qts - 19 1 y <br /> Program Element: Program Record: Inspection Type: <br /> Rou r1G <br /> 6180 Posted 0 Yes D No Permit Posted O Yes 0 No Re-Inspection on or After: <br /> �' 085_ ERVATiows AND-cORRECTNE ACTIONS Y'' <br /> C rrOaM <br /> I <br /> ItemAacation Temperatiue item J Location Temperaft" _ kern l Location Temperature <br /> Food Safety certification Facility Not WateiTemperatt e. _ Warewashing <br /> Name: Hanannd Sik: BOG OF hlorine: ppm eat: OF <br /> Exp.Date: , ink: h6- OF Quat.Amm.: ppm her: OF <br /> Received By/Title:e <br /> r ,, / <br /> EH Specialist: �/_ Phone: I/ 6 b'• /6 <br /> Time in: p S Time Out: Page of <br /> EHD 16-23(2n0 pg) 07/290 I FOOD PROGRAM OIR CONTINUATION <br />