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SAN JOAQUIN COUNTY <br />?� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s*gov.org/ehd <br />�rFar<' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 14 <br />Date: � <br />ddress: <br />rvy��Wk ,n/1 V' <br />City: G. 7 Zip Code: <br />Owner/Operator: �. <br />Telephone: <br />Program Element: <br />Program Record: S <br />Inspection Type: <br />BI SO Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />)j'jA IAA.r In 1I1,1-D'IIi <br />41. d 41A0 -UsA1✓ /h4- 113/. I f' -/h <br />EHD 16-24 (2o°P9) 4W3 FOOD PROGRAM OIR CONTINUATION <br />LA IF <br />IteMLocation <br />Temperature <br />S <br />''food Safety CertiFlca._ <br />Facility Hot Water Temperature <br />Warewashing <br />ame. <br />Hand Sink: <br />of <br />Chlorine: <br />Ppm <br />Heat: of <br />Exp. Date: <br />arewashing Sink: <br />'F <br />Ouat. Amm.: <br />ppm <br />Other: 'F <br />Received By / Title <br />ry�t/iQ <br />Qac <br />EH Specialist: rG` <br />t ,1 <br />Phone: -vtl I <br />1V <br />Time In: i <br />Time Out: <br />Pagerfl, <br />EHD 16-24 (2o°P9) 4W3 FOOD PROGRAM OIR CONTINUATION <br />