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opo"'"• c 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.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 'A/I CC> <br /> value if Address: 20r City: ��.f .. Zip Code: <br /> Owner/Operator: J v 1"�✓t I Telephone:lbq <br /> Program Element: ' Program Record: (0 c 4 GC4 foInspection Type:CM�Iu�RA- <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CUM 1q►t�l- � �iY Gt1' <br /> .e cxc urrRd an 3'14 I arzaa ► =� ifiM. t wil CA <br /> Zm it .2 rife mc"4F5N l� <br /> -uD ` Ge ar QTNOW C1UM IN- msidE f 2 tali <br /> u S D\#. Th2 t�C�l R ice► <br /> Rn OI !& on & wa,,jG\ ofd Z U'c- <br /> ti)U W11l1 \ 0QC�r►7�N cS <br /> t-wwre Thafi -fva!�1S ace Oki <br /> CutT2C }�� ­1_ 'Vr\ . Coote O e i\D't- Gfi ThZ- <br /> ec�t cAUVA feAP C,YilS*f Food w \� <br /> e iv 19-2 d Ct ` <br /> 4r 111.2- 'Wrt S r\ -Vrxe ` w A 6e l'SCU <br /> - -- — -- -- <br /> Food Safety Certification '. )�� Facility.Hot Wafer Temperature.` Warewashing <br /> Name: ilHand Sink: `FLC_iorine: ppm Heat. `F <br /> Exp.Date: �'iWarewashing Sink: 'Fat.Amm.: ppm Other: F <br /> R1 J <br /> eceived By/Title: <br /> EH Specialist: Phone: 200 /S <br /> ime in: II :25 Time Out: - 2 Z. �7> Page f <br /> EHD 1624 (2m pg) 4/3'13 FOOD PROGRAM OIR CONTINUATION <br />