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OP4ulk' C SAN JOAQUIN COUN& <br /> y� ENVIRONMENTAL HEALTH DE. ,RTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �Q.. . ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> �/FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ttS vhaal Date: <br /> Address: U-v Is s 1r k vurzO 0 City: 5 Zip Code: /1I5w <br /> Owner/Operator: t-t t,U t 9z IN lk Telephone: <br /> Program Element: i�D I rogram Record: 21 <br /> ` — 1 kA�� UInspection Type: s <br /> SB180 Posted Yes No Permit Posted -I Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - <br /> i <br /> 12 <br /> N� S�iC1 k-� ter✓ f0 VI de. On t �bov <br /> 3 vur �n )? cww vi1h <br /> Item/Location Temperature Item!Location Temperature <br /> Eo d Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: u y , y „+ C1l ��/ak; Hand Sink: F Chlorine: Ppm Heat: 'F <br /> Exp.Date: 1-L -F <br /> 1 .1 Warewashing Sink: of Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: Alza <br /> D\G•tn <br /> EH Specialist: Phone: A J► �� <br /> Time in: Time Out: 1 , T Page of <br /> EHD 16-24 (2"'pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />