Laserfiche WebLink
SAN JOAQUIN COMO <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 12- ACA C Date: €)/1 'WI 6 <br />Address:,._ Ft.'‘ v-pac t City: STD CAL1-0-0 Zip Code: <br />Owner/Operator: <br />F-- 9-F k ' <br />Telephone: qr,.) _ --isci <br />Program Element: ‘ (a c "b Program Record: ,&12... 00 ---t ssp Inspection Type:_ ccrISNAtittliCts-1 <br />SB180 Posted 0 Yes 0 Rermit Posted 0 Yes 0 I Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />0 112-0.1 icie 0 Cop flir -The \tv0M-e WaAer 1-ort-- <br />(2)- IrFtv•Act-Q- lfiw Doictr2, r)cyt-A-e , co- 1 eo,.\--- r , on boTh <br />S\CIP-- CA- iht VeA-ICA.12- . <br />C....) 7-04-icke- 501.-\-1:13e/r -ke&-k-- si-eips , <br />(5 ktf- wa-l-bc ‘ç r ?) cpt-kl) Clk"Akct\ k,(St i-6 <br />o r ur <br />6 \1'-(N' at 0 FVOCA \ACM acc,f` 024--hi-icsAke I n co a cc c <br />o - c\ 0, f-Doc) kV-and tO-f (_CI re-4 -erfr CAII 2NipkrAi-ee_S <br />vviThin 3 D a (A4 c 0 ---- <br />*- or-- -ro \-gcvi.s.._ pi2A-m . It- CA f.--‘ - e.r Th_e__ <br />---e e c) R.- 4 2_ \ f <br />- , <br />Item/Location <br />co <br />Temperature Item I Lo Temperature <br />\ d r Jae,' <br />c e Ci-e..__Packit 4 1 F- <br />Food Safety <br />Name: <br />Certific Facility Hot Water <br />Hand Sink <br />Warewashing Sink <br />Temperature <br />1 u 6) .F <br />- --- ----- Warewashing <br />Chlorine: ppm <br />---- - <br />Heat: °F <br />Exp. Date: 1 1 0 0F Quat. Amm.: ppm Other: °F <br />Received By / Title: ,I- <br />EH Specialist: Specialist: Phone: eloq ___ pt(oc6 ,,,544E), <br />1-1...._ <br />Time in: eb: <br />\ <br />Time Out OV-(30 Page 'of i <br />EHD 16-24 (24 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION