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SAN JOAQUIN COUP ' <br /> �-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: F-wa1c1 I rS MU(-tie L. Date: (L/-4/ I ?) <br /> Address: 4�q 2-5 14 , VUnCGIn CZ GI City: wtot C1 Zip Code: 6 <br /> 1159A9 <br /> Owner/Operator: V 1(itm t Telephone: <br /> Program Element: l�0�G Program Record: PRS I�' l Inspection Type: �1�n��fic <br /> SB180 Posted Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> DQE'; OBSERVATIONS AND CORRECTIVE ACTIONS <br /> N1 vivte4tiu ►S c-vrrec+ed Q X(V' i- <br /> NOfi C01 •v"tL CkVe c avvfi.Qcl I t)ctde trO "2 Cj(- ccVlar Gli' `r� <br /> Pet i Y-i+C b.e n . U nW-(,S T-OCO K. OLE-V J,el he i used ccr'4.'6'1f <br /> all fWd cGria1ne-rS vnTh lWic,, a crr "OL . <br /> pec t- lnmN <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature T Warewashing <br /> —._..-_..-.-..._...........:_.._............-- ---- ..._...__.._....— --.... .... _.................... <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: r <br /> EH Specialist: Phone: 2Gq _ b 54A(o <br /> Time in: ` I CY Time Out: 1 :06 Page of I <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />