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SAN JOAQUIN COUP I <br /> � •.pG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si- ov.org/ehd <br /> �IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L <br /> (O VLh GY-�KYZc.r_c � r� Date: <br /> Address: LlO _r <br /> 5 <br /> M O h City: C�^ K t Zip Code: q'5 <br /> S�O3 <br /> Owner/Operator: Vol-h'0-7 -S U �1_ Telephone: & y el_l q 16 <br /> 0 � <br /> Program Element: 1( Program Record: P Inspection Type: I OC4 +'n,C_ <br /> rd-18—OPosted )(,Yes No Permit Posted )<Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 11 nnctWas n s'I C wQ <br /> C 1 Q r i 4-r- S,-'4c r <br /> bwa� w <br /> n 1-C Se r <br /> Vn <br /> Y r0 r ,z C -ea <br /> Olr <br /> Item/Location Temperature Item/Location Temperature <br /> t� aa-4-L-L, �� - Li <br /> of AD <br /> L G <br /> �kJ n <br /> r <br /> CtCr <br /> food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chine: + �D ppm Heat: of <br /> Exp.Date: areashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: OL4VPhone:LAI D15 —.1 y I--? <br /> Time in: '-j D Time Out: [[ /• J 2 0Page�of y <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />