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SAN aJOAQUIN COUI ' <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.si.gov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: va - ,T T <br />Date: 112,111 <br />Address: I �)� , City: <br />Zip Code: <br />Owner/Operator: <br />Telephone:' vv <br />Program Element: I , 3 Program Record: C� j <br />lA <br />Inspection Type: <br />W <br />SB180 Poste \Yes No Permit Poste Yes No <br />Re -Inspection on or After: <br />r OBS RUQ TJt?NSAND G RRECTJUYEpeCIONS"`` ` i ..E .. <br />d C4 <br />4t-=lamq <br />�6 ! U31�� <br />L M' A-gkc) <br />��a <br />a <br />°'� t�"mlLoea'L"aii'.. em [atu egg <br />; 0 <br />t�`t mNlocahon <br />_ss <br />€'� , ad;Sa Yfifi 60h _ <br />Name: <br />F,acd mot mater-Tempar�tuce��' <br />Hand Sink: 'F <br />� ."� t'�,�,;`'W.,ewashing''s u <br />Chlorine: PPM Heat: `F <br />Exp. Date: <br />Warewashing Sink: `F <br />uat. Amm.: PPM Other: -F <br />Received By/ Title:�--' e <br />[-/ <br />EH Specialist: Phone: 1-(oe- O U 1 <br />ime in: Time Out: Page /ofl <br />EHD 1624 (2n° pg) 413113 FOOD PROGRAM OR CONTINUATION <br />