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,-co VVIUtV1 i/V <br />Owner/Operator: v_tts <br />Address: <br />Name of Facility: IC c.c.s <br />Program Element: / ;if Program Record: C tlf g <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: t 2_ '7 if ilp <br />OBSERVATIONS AND AND CORRECTIVE ACTIONS <br />V\AL— 4 <br />-aDP‘4-cine.a-l-te ttiCU stiv)1.0,1 . eA,v,4 to, <br />Name: <br />Exp. Date: <br />PPm Heat• <br />ppm IOther: <br />Warewashing Food Safety Certification Facility Hot Water Temperature I <br />Hand Sink: F <br />Warewashing Sink: 0 Quat. Amm.: <br />A <br />vdi„4 <br /> t/t <br />Temperature <br />Phone: <br />Time Out: Page3of 3 <br />Temperature Item /Location ltem/Locati <br />APte <br />,PAct4 <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Telephone: ,feto y <br />Inspection Type: <br />Date: <br />City: Zip Code: <br />SAN JOAQUIN CoL .1f <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orci/ehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />FOOD PROGRAM OIR CONTINUATION EHD 16-24 (2^d pg) 4/3/13