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oP4"t". SAN JOAQUIN COUNT. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton; CA 95205-6232 <br /> �... a Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 9G%FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> ame of Facility: V i k D pV- Date: <br /> ddress: - CAr e_ r elr City. 6 � Zip Code: /]�l C <br /> wner/Operator: r n . S}n Telephone: f_'I <br /> Program Element: I bQ .0 Program Record: u U I-(CA I - Inspection Type: ccT&A lip-hon <br /> 8180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: til <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> LIL&II 3 42 <br /> 1ll,Q CivJllQrr`5 i�Uf�� u� I.eUS}- L " tz> ��`�h <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification acility Hot Water Temperature Warewashing; <br /> Name: <br /> Ian Sink: of Chlorine: ppm Heat: eF <br /> Exp.Date: washing Sink: of uat Amm.: ppm Other: of <br /> Received By I Title: yJt e NV <br /> kp— <br /> H Specialist: Phone: (A/7_ 1-6 S _ It-CO <br /> ime in: ;( � Time Out: ,25 Page 'of <br /> EHD 1644(2n0 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />