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SAN JOAQUIN COUNTY <br />_ y ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cq�IFeaa�P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.ora/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: U .$ <br />/ a v e <br />Date: ( <br />2 Z <br />ddress: <br />City: S O aN Zip Code: <br />Owner/Opemtor: <br />Telephone: <br />Program Element: <br />Program Record: (� / <br />Cn �_ Inspection Type: <br />b <br />B180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />✓P �I <br />I <br />U f <br />tj /I / <br />".1 L 4 -C <br />i?a /? /vck/Gi�2cl <br />` <br />CiC Ci.VI- <br />L <br />ItemlLocation <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: <br />Hand Sink: <br />"FChlorine: PPM <br />Heat: <br />`F <br />Exp. Date: <br />arawashing Sink: <br />.F uat. Amm.: PPM <br />or: <br />of <br />Received By/ Title: <br />1 ✓ ✓ S 4A <br />EH Specialist: 0--y— c, <br />o_ <br />Phone: <br />Time In: <br />T'- C90 nM <br />Time Out: / - '� q L /lam <br />'ZPage of <br />EHD 16-24 (2b pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />