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°"'" c° SAN JOAQUIN COUI <br /> �o c <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ;P. Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.slpov.org/ehd <br /> 4�iFORd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f(�(,IICI I 'S ck( ('Zt" N L Date: ';�/ 1 A 1 13) <br /> Address: 41o2,12 N • but)((An V-a City: w hGH Zip Code: 3� <br /> Owner/Operator: ; Telephone: <br /> Program Element: 1 ko `r, Program ecord: pR ok 10 t q tb Inspection Type: 1w1 T\P- <br /> SB180 Posted Yes n No Permit Posted Yes No V Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ml?cr� ticcr kr be1k is r,dwu i fICA cv* <br /> \oCU_�e ck;car Gr �nctul\ a lO" S \oSh u ( S ,nws5 I) on <br /> Nlan6vaSh 5i n\4 to • CC'rreC+ b 2 wiz e.14-s <br /> $inS wiTb nct:;6laS G-tz�ed tie 1z iiiPm�r�� nr6 wGWs• 1f_kn <br /> a fern vfaS t \\6 - 130c1F . Mak0Wj0 hot- fo S, C 135°F <br /> h� Cur-re& k m r'n ed1 q�e_[ <br /> q D ef� oP st�121� S C+I MbSt wwcn a1�ef5 . <br /> 5vrxe I n 1 a LOa l ah tot cup-o, n er k-ock <br /> ,() SIiC>Zd rC.Cr fi eF r_W �P 10Z Deli CC,10,e WDA , Ot °r• -(.rW <br /> d -�- 0,r \�IGW +to IF:. CC(-f,G[il' a , Pt 0 = Meat VJCkS he i nq S C0-C� <br /> urin <br /> 1 Trod burnt- Com+ 1i fi bulks iT)C"Je o(crhol waIY-- -rn CC-XWf, <br /> ih5 `VN -Wo xj,;& , <br /> Produce va\r<;n ccx�tU his war IQu -From (fine- 0i- fire s;ny-- s' <br /> WIMIr WfAy- '11\ _1W0 \W_ s Vo no-k- StZT& rQuGt 1v :eu+ Mds Ietcw \ear-, <br /> Kli-�) rbow 2-C Ur Sl n Y-- haS a 1.Q Q +0\yCPQ'. W �R I n -Wo Wee tSI(,G O�"Mu t-Con in � �r ;n lru\fiIPIZ \oCGti►�nS (Tvdinn�s J\)'lCj2 CUD& <br /> ;A- and 1 ce, Cv-&t oVPFI;61 V- Ut\i i_ b 2 we¢�Ls <br /> 1 o ed a sin Id "k4e i'090e 1cjl, s self she CCAWK . p SC(Akd bh.elf <br /> f dui t fi U I C 1 um�c�� i U . =1- d oa r -1-0 C 10se i-n ,Y e <br /> Temperature <br /> Nu r wush�n obSPTv <br /> aCb (qvU I 10 -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Qua .Amm.: ppm Other: of <br /> Received By/Title: <br /> r..11�-• ��.�, Com,,, <br /> EH Specialist: Phone: 9-C ,^ ,Ir d�� <br /> Time in: Time Out: t ( :5 C) I Page3of 3 <br /> q . <br /> EHD 16-24 (2n'pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />