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0V <br />oP41Ity.. C' SAN JOAQUIN COW <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• �q.., ��P • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.si4ov.org/ehd <br />�IFOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:C V <br />Date: S <br />J <br />Address: 7` <br />i <br />City: 1 <br />Zip Code: �S Y <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: <br />Inspection Type: RC N hC <br />SB180 Posted Yes No <br />Permit Posted Yes I No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />U "v1CAa-1OY15 <br />Item/Location <br />Temperature <br />Item / Location <br />1 Temperature <br />Item / Location <br />Temperature' <br />Food Safety Certification <br />Facility Hot Water Temperature. <br />Warewashing . <br />Name: �/V ik <br />Hand Sink: <br />of <br />Chlorine: <br />PPm <br />Heat: <br />of <br />Exp. Date: <br />Warewashing Sink: <br />of <br />Quat. Amm.: <br />PPM <br />Other: <br />of <br />Received By / Title: <br />EH Specialist: <br />L <br />Phone: <br />3�6 <br />Time in: ; �. I �� <br />Time Out: <br />Page of <br />EHD 16-24 (2'1d pg) 4/9/12 <br />FOOD PROGRAM OIR CONTINUATION <br />