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,v.P" >•.cA� SAN JOAQUIN COUN <br />' ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: KAQ I:i �S <br />Date: / <br />ddress:City: <br />Zip Code: <br />5-Zps- <br />Owner/Operator: ejA/YtAv <br />Telephone: <br />Program Element: Program R ord: Pr) �� u <br />Inspection Type: <br />8180 Posted s No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />�` Godz ut�P,✓�e�,�f[D� (M rlon•- . 19�t �'S1""_sl—lr��v�� <br />6„ <br />O - to 4 o1. <br />Item/Location <br />Temperature <br />Item ! Location <br />Temperature <br />Food Safety Certification Facility Hot Water Temperature <br />Warewashing <br />Name: and Sink: <br />.F hlorine: ppm Heat: <br />.F <br />Exp. Date: arewashing Sink: <br />.F Oust. Amm.: ppm Other: <br />.F <br />Received By/ Title: , M <br />v�� <br />EH Specialist: <br />Phone: <br />Time in: 1 . .L,1 <br />_\ Ilh <br />Time Out: \� _ <br />Page of <br />EHD 16-24 (2° pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />