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oiggwAl• a SAN JOAQUIN COUNTY <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q• .a <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> c;Fa•R� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A"�� fivrA-<,S Date: 3-6 <br /> Address: IG R 11-tTizg1w &-) City: 1,0�raN24'P Zip Code: C -330 <br /> Owner/Operator: l I L 14 f`Ur.- PHI-e-4 I11/C Telephone: 3 Z t- /G Z <br /> Program Element: 1601 Program Record: 5Rrxn"477 ? Inspection Type: <br /> SB180 Posted i Yes No Permit Posted L.Yes No J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1/J6 2 A 0e arSyiveys�,� oftRc , <br /> �'�RI► cff6q4e1 ' 44- 14- 7- C/" 'f <br /> NA <br /> �C A"65 H HAxlbS 5 rG.v s //y 5*7"//A0wP?s P05 T F uv► Tat�6 5(brus <br /> /-/#S /9 G19P PjL4TkAsc4) 7oP RiAt 1'iNb &)VA1. EAixi,mwrF <br /> fJll�s/fPS rn+�rFe��»y <br /> © 0,1R,- 9f&T1tW K/ot/UD 7_)1K,15 e-Ej95F 53Y V-4-o? 564ow Cid f a f-)953'IA r. <br /> �y S-G•o <br /> S ltriR;ae, GROUT rSivaT Co�PNc- �y 5��9sf� SFS-[ 1%) !tilt?q Scr-tcr�rHlSuei9��cf <br /> �G�+�ti�r3�E"/Jr1rb ,t,�v- r9r3 SoRrT3�T, P MH�cA�syi�iy <br /> QGvNEQ 7bRPJ 70 I�pC3� 6 41 A, ITRKT S1WitToIU <br /> P19 , <br /> N /4Nu41'� A , <br /> 1� y"tT Y� — 19NJb ka&6141- /Wi)f NrI.�T''1 �Rn+•s , tMole!dr,y?0�y - — <br /> a'K ➢n l SS ccE R'Wt_r oU /P - pRr�� 961 MaxW cu P7yi SEny`inC <br /> l yqX 3 to 4o,*7*P- 1,,tl-,g 1�c69 M J7 �15 51retlk<V _ REX*t> <br /> IternrLocation T•emperature Idem;!Lpca n Temperature ken/Location Temperature <br /> &R, ocrot- 5 01(_ R-PSP 3 <br /> Cv(AL 3© rr 2 0192- r(u p 3 <br /> It*-� y i 'l) ASbx 3 <br /> Food Safety Certification Facility Not Water Temperature Warewashing <br /> Name: Hand Sink: 13/ aF Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: /36 of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: q& p `3 rY -? <br /> Time in: p ;y Time Out: l IUGR U Page tof <br /> EHD 16-23 (2m pg) 11/06/018 FOOD OIR CONTINUATION <br />