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oPA""+•. SAN JOAQUIN COUNTY <br />b a� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•c4.,•,,. , .�;;P • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />CIFdA <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: yet <br />- > <br />Date: I <br />II 2- <br />Address: ` or ., S <br />•c,V <br />City: <br />I LCCk Zip Code: <br />Owner/Operator: <br />kv <br />S <br />Telephone: <br />Program Element: 1633 <br />ProgramRecord: rKo s-1 6 3 / 2 <br />k� <br />Inspection Type: <br />Set 80 Posted Yes No <br />Permit Posted Yes No <br />Re -inspection on or After: <br />IONS <br />CTIONS�, <br />Q <br />'vCt <br />e 1 <br />, 1 <br />ItemlLocation <br />�, Temperature <br />m !Location <br />- rature <br />f) <br />Fo_o_d Safety Certlttoati <br />cility Not Water Temperature <br />Name: . V^GL;S R., <br />and Sink: �z <br />'F <br />Chlorine: Ppm Heat: <br />160 dFExp. <br />Date: Z2L <br />rewashing Sink: <br />'F <br />uat Amm.: 3� Ppm then. <br />Received By/Title: /1 P .1/'�!"1 GWh e/rJl/JrrU'�pf <br />20 I Q'yS�7 <br />EH Specialist: <br />Phone: 7 n — / D <br />Lam'- , <br />ime in: 2 , <br />Time Out: 1 7,,k S PH <br />Page of <br />EHD 16-24 (2m pg) 4/113 FOOD PROGRAM OR CONTINUATION <br />