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SAN JOAQUIN COUN <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.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: vt_lcf C Date: <br /> Address: City: t.: Zip Code: s <br /> Owner/Operator: ,,�` Telephone: <br /> Program Element: Prog Record: Inspection Type: k t <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: T <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - - <br /> Item/Location Temperature ` ' Item/Location Temperature <br /> Food Safety Certification i Fad— Iity Hot Water Temperature Warewashing <br /> Name: Hand Sink: I�� of Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: Z� of Ouat.Amm.: ppm Other: of <br /> Received By/Title: — <br /> EH Specialist: 6 \ Phone: <br /> Time in: ,Ll \N Time Out: I-Z_ J Page?bf-11 <br /> EHD 16-24 (2^ pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />