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Pou�N SAN JOAQUIN COUN`� <br /> �o ,.. .......c <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 6... ,...�;P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility.- �W •`• w 77M CUA C1n(,� C Date: � b ) <br /> Address: Cu n+ ! City: 'CIA `, J Zip Code: p P_9 f <br /> Owner/Operator: C-,U f i P P-1 x I v,P� 1 vlJr Telephone: 2 oq__l) 15� <br /> Program Element: a� Program ,Record:C)U r1 Inspection Type: OTkSu� <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> N U V'1U\C1OILS CA-V i fiIT) <br /> c + �s �u <br /> Item/Location ---- 17-Femperature 'F___ Item t Location Temperature <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: r1: Time Out: .n e\ Page of f <br /> EHD 16-24 (2n°pg) 413113 `V FOOD PROGRAM OIR CONTINUATION <br />