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aPauttl. SAN JOAQUIN COUNTY <br /> ®Ea AG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �qt Faa�a. Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.S6 ov.orct/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> rr �3 <br /> Name of Facility:AWIMDate: I <br /> 7 n� - <br /> ddress: �� WU 1 �! City: Zip Code: <br /> wner/Operator: V Telephone:ovk r' ,_.tyI S <br /> Program Element: Program Recor 1 I .. Inspection Type:O�"l <br /> 8180 Posted Yes No Permit Posted Yes No l.V Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> JA_I - r o - <br /> 1 GL VA12tA__ 112 <br /> .e <br /> wa s <br /> F. < <br /> n <br /> e I n cb VrFrttt <br /> - 1 on <br /> -tom I Vq'&M'& <br /> SS <br /> mlLocation Temperature Item/Location <br /> .Safety Certification Facility Hot Water Temperature Warewashing <br /> nExpDate!-: <br /> Hand Sink: of Chlorine: Ppm Heat: <br /> arewashing Sink: of uaL Amm.: ppm Other: <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> me In: I ,.11 am Time Out: lY ✓T/ Pa <br /> EHD 16-24 (2b pg) 4/3/13 <br /> FOOD PROGRAM OR C <br />