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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.segov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: VA_ u I S Date: Z t <br /> Address: Sct Lm tv "l City: Zip Code: <br /> Owner/Operator: L Telephone: <br /> Program Element: /. 5 Program Record: Inspection Type: 1 _l 1 lf1 <br /> SB180 Posted es If No J Permit Posted Ir <br /> es ❑ No Re-Inspection on or After: S r <br /> OBSERVATIONS ANO_CORRECTIVE ACT IONS <br /> ce 6'd h <br /> GL � vn� Gt,f ✓Gv`�-r'�t— C✓D t l� vtu�4t,+�- • - <br /> (�ad-t�Q -- <br /> {-- <br /> &v,jL sa ,4,. a C <br /> v S d k- GI 'Ae✓ 'WA <br /> 9yMC- V"t- ylel <br /> - <br /> b�wLe.a� <br /> &l-tWLCA e f ova- ^4- 4Vv► ',— • c v a <br /> !-Cts c2 I 6vpv fi 4k- AWL - <br /> q v a a K Pltr � ►K e I/V <br /> OW AOK—A-fn LA" 2 lad F <br /> ., Vh <br /> t w � ���i �-v-� �t►�,Gt�iw-uy�- (�v� <br /> - � <br /> Name: 11 �U4_0 G I �/�yj� Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: V arewashing Sink: U of Quat.Amm.: ppm Other: of <br /> Received By/Title: � <br /> EH Specialist: Y1^/i Phone: Wp& <br /> fj' <br /> i <br /> Time in: � Time Out: [[ Pag of <br /> EHD 16-24 (2"'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />