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,o•P` •�oG SAN JOAQUIN COV. .Y <br /> H ZX ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.....r ;� Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sipov.orq/ehd <br /> LI FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 17 f- A Date: <br /> Address: ✓ City: `/ Zip Code: <br /> YY7 U r? •�" <br /> Owner/Operator: Telephone: ��► !b �? <br /> Program Element: ! Program Record: r� Inspection Type: <br /> B180 Posted (2—s') No Permit Posted No Re-Inspection on or After: oZLt�P <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I <br /> wy- ' n.IL V nd e r '�-C.or►-�P 5 i �L (mss h o�_ G u <br /> 1 , <br /> C.IZ C4DO S r c� es u r fA C& L CTU <br /> r� ' bco <br /> -e r KA S ' n t r5 L rou- <br /> ' "n-C S , <br /> r - v v1rv r n <br /> Pe <br /> cam► K CC a Lk-7-:X4 r (-e._)t_kri 10 r <br /> ra if c F R S , 4-6 PA A &rDV . <br /> - LA <br /> + - 34 5� ►-, <br /> o wt t_b 5 i <br /> Item/Location TeMperature Item l Location Temperature <br /> AP <br /> 10, <br /> n d c�i _sV1ex <br /> tt? 1 II— n _ _._ <br /> Food Safety Certification ( Fatality Hat Water Temperature Warewashing <br /> Name: (Hand Sink: of Chlorine: ppm Heat: of <br /> Sc _ S 'F f► leo <br /> Exp. Date: warewashing Sink: r of Qt.Amm.: a ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: !J _ <br /> 99 112 <br /> Time in: Time Out: ,�O Page of <br /> EHD 16-24 (2n0 pg) 4;3/13 FOOD FROG AM OIR CONTINUATIOP4 <br />