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oPq�1N SAN JOAQUIN COUt <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> /FORIN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e v� VU C h Date: <br /> kA- <br /> Address: 21l„ 1 1 City: i�1 u Zip Code: q S-2"40 <br /> Owner/Operator: Be- �1^� Telephone: 323_b3CL2�' <br /> Program Element: `koI' 1 Program Record: ��� Inspection Type: - <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> oin <br /> Item/Location Temperature Item/Location Temperature <br /> - . . ... ........---- -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -. —.._.... .......................... <br /> —.. -- -._.. -Ch- - --- PP -- _- <br /> Name: Hand Sink: I i of lorine: m Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 1O�© Time Out: bJ � , Page of <br /> EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />