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�0 eoa SAN JOAQUIN C'OUA <br /> N: :, X <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.s'gov.org/ehd <br /> �IFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Address: <br /> GI Date: 9,722- 13 <br /> Address: Ll U 31 City: r C+ Zip Code: 3 <br /> S" <br /> Owner/Operator: Telephone: <br /> &;r3.7 00 ; I <br /> Program Element: Program Record: Inspection Type: <br /> 6180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> s. OBSERVATIONS AND CORRECTIVE ACTIONS <br /> M . 0 b c ve. ('4 rrl <br /> Gh5 4 cc, h b e k yj cAd C4 U) <br /> rro u) are Wp5h , 61r11a 3- jcdav <br /> d 11 fz do . j h .5 ke J. <br /> 11 a-pe(4rnc ,I .� <br /> C Gtr q P C6A lti S <br /> O , (A j r) 40 r C1 A 114 c r r v ar ej. <br /> 4 l2 ; tCl n d (be e 5 4 of h, 1 de r- <br /> 3 <br /> 40 q Y4 b le . S aorP o , C- Or) S tr'l4ri'7Joble <br /> recJed. <br /> S c Joro on ; Ch ; nr c <br /> c e 5 r cc o ) h ci l 'Icible Ceo 1G ; n C r, Gfle t. r <br /> 40do (( rroch,,d <br /> 6 cv ee W r% &,1\5 c-/1 clrctlbPfN/of� <br /> 1 Gs h cl <br /> r e C1 <br /> fore of ndor rp li : y jpfa ) ; on do r c A <br /> I/ b ) wP r u3ns. cc /r tje <br /> rdbo(%,d A, )I y S be If %r S ; ►, !1 -tis ; Jrn7s. Relwc✓a acdr, <br /> n� l : 2 <br /> '`ItemlLocation Te perature_ Item/Location Temperature <br /> kviAdol a-door LIl r -i n �l - f�A�ati Jo i t , <br /> -13Si nrr'j CU ! r- <br /> Food Safety.Certif!cation Facility Hot Water Temperature Warewashing <br /> ......- --- -- _.._ ..--- <br /> Name: Hand Sink: of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: Z/ of Quat.Amm.: PPM Other: of <br /> Received By/Title: 'O / r G Is <br /> EH Specialist: Phone: /- L <br /> Time in: Time Out: �i t� Page of <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />