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SAN JOAQUIN COU <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �4.., :a .alp• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V'p Date: ,I ,f S <br /> Address: 1 City: C��A j Zip Code: S2j p <br /> Owner/Operator: ���f.t � y— <br /> t KJO� I Telephone: g013'SL4 <br /> Program Element: 162-4 Program Record: �2p5�z U� Inspection Type: <br /> ✓`� <br /> SB180 Postedv_rYes No Permit Posted /-Yes No Re-inspection on or After: <br /> OBSERVATIONS AND C013RECTIVE ACTIONS_ <br /> _ . <br /> .� 1 �v'�(---- - Vel &s Go L,6 . C41 of nS e --��Lu--Ko 0-3- <br /> - t_Xy't-a CkA_ 200W? <br /> m ►r" )'t.�c �e t� <br /> L,-3 O—LK-�r-, a-D r►r-L-0 Cs- hAv.e- d <br /> 1 e"� n 0 _----— <br /> D 1 2 e�Y ' I-�', �� -F— vcu Lq--tom(_Q_ 1�- <br /> V <br /> n ri Co ?f! v S { <br /> Item/Location Temperature ( Item/Location Temperature <br /> .2-Cleo V- ct>o Ce v- <br /> r CLOD Ca v- FM n� - -- �-(I�� nap a+ bay t t s <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F ppm Heat - �F <br /> Exp.Date: Warewashing Sink: <br /> `•� of a_�m�m.: uQ Ppm Other. of <br /> Received By/Title: <br /> P <br /> EH Specialist: Phone: <br /> Time in: Time Out: �� PageZof <br /> r, ' l <br /> EHD 16.24 (2^ pg) 4/3+13 FOOD PROGRAM OIR CONTINUATION <br />