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SAN JOAQUIN COUNTY <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464 0138 Web:www.sicaov.orglehd <br /> Li ko � <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> OwnerlOperator- V�� C ? . Telephone: <br /> Program Element: 1 Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No l�to Re-Inspection on or After: <br /> "OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e <br /> In�41 <br /> '^ 420S <br /> ro N °✓� L r <br /> w <br /> ' ZA4,,t - <br /> oo v <br /> vr�v <br /> 101, 111 LlL <br /> A", V UAZtifN Ll ate' <br /> r ftemlL cat`P Temperature item!Location - <br /> Food Safety Certification. Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F uat.Amm.: ppm Other: 'F <br /> Received By!Title: <br /> EH Specialist: ,,-�rfj� ,�O Phone: <br /> Time in: Time Out: } r Q� /�Irl Page of <br /> EHD 15-24 (2ntl pg) 413113 ( f ( FOOD PROGRAM OIR CONTINUATION <br />