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oPQ�I" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �ikoaN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: W o 4 Date: \C)/2-()/14- <br /> Address: <br /> C)2()Address: I r'y 1-5 Y_ *,V T(0 City: Vmcu n Zip Code: r1 D 2:;N _ <br /> Owner/Operator: �yJ v 't,/�Q�rV � Telephone:�"l�� i����G <br /> Program Element: r�0 Program Record: 2 /_. ��� Inspection Type: C�1C <br /> SB180 Posted Yes No Permit Posted Yes No ICJ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> • ave c..lQ acd l�,r �S f Q 1 ,� C 5 `� `�� <br /> �- OL tir r-vtV- qo-� r l AA _ VAWS-F -t-o rte= cX <br /> e\Dw <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: U1 ,v 'i� � O( !, Hand Sink: co of Chlorine: ppm Heat: of <br /> Exp.Date: /L. ` �(/1 arewashing Sink {X 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: s f_ <br /> Time in: I U. Q� Time Out: 0- � � Page of <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM 01R CONTINUATION <br />