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op441!M. �, <br />;.�..� SAN .JOAQUIN COUNTY <br />` ENVIRONMENTAL HEALTH DEPARTMENT <br />V- W-1 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: • 7 <br />ave '— <br />Date: 2 <br />Address: y, 2N <br />{z `vCity: <br />w <br />0 � 1 �n ZIPCode: :_` "–( �O <br />V 1 <br />Owner/Operator:: <br />Telephone: <br />Program Element: \b3 <br />Program Record: "�s Z tO V k2) <br />, <br />Inspection Type: • �� <br />SB180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />—U <br />L <br />2-02--3, <br />o� <br />F <br />Temperatures <br />- Item I Location <br />77 <br />-Food Safety Certf-rcation-,.-_ <br />Facility Hot Water Temperature <br />Warewashing-. <br />Chlorine: PPM Heat: of <br />Name: <br />C.. <br />Hand Sink: <br />'F <br />Exp. Date: <br />arewashing Sink: <br />'F <br />Quat. Amm.: PPM <br />Other: •F <br />Received By / Title: <br />EH Specialist• <br />1__ 2 J �2� <br />Phone: ?-09 _ 101`r <br />Time in: fCl <br />Time Out: 1Page of <br />3 2 <br />EHD 1624 (20 po 4/3113 FOOD PROGRAM OIR CONTINUATION <br />5 <br />