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SAN JOAQUIN COI ;Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 84(IFoq�p.. Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sioov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q .P— d"VLO Date: (O <br /> -3(- <br /> Address: �.� Vp <br /> City: �IVC�� Zip Code: <br /> Owner/Operator: G �►'C�i Q V Telephone: <br /> Program Element: Program Record: 1 O O I�Q ��,2 Inspection Type: v <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (UII IS vv" Ung �-eq 11-h R-rIn t <br /> 1 <br /> Coll L U - <br /> �- <br /> t� <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: -F Chlorine: Ppm Heat: -F <br /> Exp.Date: arewashing Bink: -F Ouat.Amm.: Ppm Other: 'F <br /> Received By/Title: - <br /> EH Specialist: I Phone: <br /> Time in: , (� Time Out: - '7[-- Page of <br /> iLL <br /> EHD 1624 (2-pg) 4rXI3 _" �-U FOOD PROGRAM OIR CONTINUATION <br />