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0P ' SAN JOAQUIN COUP- <br /> Q` ENVIRONMENTAL HEALTH DEIJARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ;P• Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> 4CjF�'�e� <br /> /,1 FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: CU�i� '3� f t I� t-� i n I?,'n- Date: i i IC( 13 <br /> Address: ? a OTOJ i.• City: rStoc� Zip Code: -5 *2_ <br /> Owner/Operator: r} U Q L•y`0f)U �o 1_31V ft Telephone: K <br /> Program Element: 1 b ` P gram Record: }i h j ' r� Inspection Type: n O <br /> SB180 Posted Yes 1 No r Permit Posted eslL❑No 1 Re-Inspection on or After: C• <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I & 1S I +[Jr l+ I L(A 170A S <br /> rpt �n hus <br /> M00 cind ( jMn tdt wit-h bIR-lCh <br /> lie& cifg in Tbe, faUli+ M .e o) <br /> S ccx tcl - <br /> OAe4- - - 2 Si10Y- i 5 Cl�- 1 U(a "F . 1-6 <br /> hNh" a <br /> oal i cxen i S1- u -I- <br /> a� <br /> b IC i"1O CSI 1[1 cnSi i (� COVtaT t-Je i ad" <br /> �7 <br /> -((-4- rd 6ejAj& QVTQ kte Ccx IleAve; , <br /> Oil +_ fto± T)o &M •rd 6a i n use <br /> CCOrTe r 1 �.' 0 0 l✓-_ . <br /> Item/Location Temperature Item J Location Temperature <br /> -- <br /> WCJI Y-- it's (CVIAT <br /> Food Safety Certification Facility Hot water Temperature Warewashing <br /> Name: NCA_tAi lU � I j 1f�L3 Hand Sink: 1 ii(J 'F Chlorine: ppm Heat: °F <br /> Exp.Date: 2 00 <br /> A arewas Sink: � , 'F Quat.Amm.: Ppm Other: 'F <br /> Received By/Title:,,- <br /> `i I' <br /> EH Specialist: Phone: G— <br /> ime in: `1� % Time Out: :o d T�i Page�of <br /> EHD 16-24 (2^a pg) 4/3/13 V FOOD PROGRAM OIR CONTINUATION <br />