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¢aU'" SAN JOAQUIN COUt� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siclov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: M 3-f'j 3� Date: 1-071-16 <br /> Address: -13 /�o1 -A. 0y-r-« a City: 54r>�,�to'o Zip Code: 96-203 <br /> Owner/Operator: � 1 , n Telephone: O <br /> Program Element: ( (G 00 Program Record. OO Oa Inspection Type: P-Pu <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> ,...,,.: OBSERVATIONS'AND CX3RRECTIV AICTItNS .. <br /> J17_ru CK s i s e(%e. �(�e�n em � 6(4,+ -Fkj rt_ i,6_. _-e.K v '5__ <br /> -----clvi.s. sz rid 4�C_._--_ I oo rYl of And ��rti.� 3 d a A L Go►2_ 4... -4 <br /> ......... _ _ _c Q n - 4 -e---U ---+0 -- 'j p food —4c e._her+ ,) , <br /> 'vcC rv� -► a h --51-i of L( - ---- d- i ... c (_o a n....d._.....__ ---- <br /> 04 - <br /> r M C14 5 R47..S0 r of r_e ..._ V-t_r "-Lot - <br /> --_I1 C-h ss N� s <br /> r_�?V_p xx4+t. -fir w-!IS �h _.._ .� s�.r...._ b I-2Z S <br /> W a 4-t r U__ k. Uri dt Y- <br /> on <br /> w a� <br /> on a r Kan L64 , a.i Ir a Us w o-t-k:�•-L 1 w.o-e.K . <br /> X1' 1 vVa ,� P.... ._._-{-ru rK Llect 'n ......... ot n d {-�r.Kt _d.._.......-v <br /> W i-4-h V%e c.-A r-t v, 5 f t Lt <br /> ltenVLocation Temperature Item/Location Temperature <br /> r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 17 r� 'F Chlorine: ppm (Heat: F <br /> Exp.Date: Warewashing Sink: I2D 'F Quat.Amm.: ppm ',Other: o f <br /> Received By/Title: fi f, <br /> EH Specialist: - '^ -„ _ I_ Phone: p I-� <br /> Time in: „ Time Out: Page of ' <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />