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OP�uIM'•C SAN JOAQUIN COUR <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:vvwwsiqov.org/��e� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 CVLG'Y 6��G�j Date: <br /> Address: / �L�, rY r� City: Zip Code: <br /> Owner/Operator: 414 . �f �fl _h t �Q� Telephone: <br /> Program Element: S� Program Record: G S Inspection Type, <br /> B180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIC}NS-AND CORRECTIVE ACT S <br /> �Vva G; YI%r 1c-Lkr <br /> d �,t C4 (� <br /> ti o rt. AV- (o <br /> AP' W -.f� <br /> ID <br /> Facility Hot Water Temperature ° IVar ashing ` <br /> Name: Hand Sink of Chlorine: ppm Heat of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: i 3 W, Time Out: Page f <br /> EHD 16.24 (2n'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />