|
SAN JOAQUIN COLO
<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: _.---- ‘9I Aitt t M rd Date: k t, / 1.3//t1
<br />Address: '.---_;—__SO r\--1 City:
<br />. Lc-,---v J 4...:0 y\Zip Code:
<br />IZO• rkek,
<br />Telephone:
<br />Program Element: Program Record: 3- ..--- ple._,0 (I Inspection Type:
<br />0 ---(1.13
<br />SB180 Posted es [1 Hermit Posted yites 0 Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
<br />a 0- 1\-4 t r i , c. vi . ._ 0 di piwi 3) - to f os i k k e ek. ez% ,A" & ? - - _
<br />(r) 1 7-1° F t D° C ttr- O747 , rta
<br />II •4 (d:fi IL VP A . 6 • z? f',-(}c ) 644,4 - i.„A-- i_!
<br />0 V 5 50vel , N, ODA 61- 4:kfL 4--a.tii ) s
<br />—Pro-v4 60 Ct, k___ ---CI— 6 oy--Jijqj v't ot u 0- or itkeN c
<br />-I ilo s)1 LA, et ricz tici 1 T-Es let pet i r - re: I ris-i---' ( , _ V
<br />(,1.1:7blit,'-t '..1 et) rctwee r-r -e_ci-fri lq.c,e c _ ,_a .(1
<br />C -C 0 r - rt s) -to i w c • yx e sj,c_e li cl. . c 0- -L 0 oti.) 0 1 iL ,
<br />12 1 t e IA re 11 .s.p7c-t-lov% t .
<br />N o4- ck.. co 12_ Ltile---es Ini,, ket cnic4 1 , J2 rok..-C-of' a4c ULAJ 4+72-Y- 1A.Qa:4-12)' -Op r 0,43 r
<br />as-b2 Apicceai— vivg_. un • r -1-1,ttr V._ Uev, I
<br />re) w141 C t7. to
<br />b . y, 1
<br />
<br />i f\Q—Ve-
<br />o
<br />t'ilAci iCtotil:r. 4crykillet8re-
<br />
<br />ti.e. ii c 4e. ;4tAv° -t 0 tfirA__ VIAP 0-Ed • , , , AA f. , , .1 * , 1.1 1 / A ' — — . .1
<br />r _ # ,A I (A) I ,1_, kig " • CX ' A I or—
<br />..tr
<br />a il ok .'4 ,„. rip . ,..., Ei t c.. C ‘.1_.0 C i . 4,.." _
<br />Item/Location
<br />-t--4VK i Le_ck_ ±0 r at
<br />Temperature
<br />...,
<br />Item / Location Temperature
<br />I
<br />..ko c...c5iti2_ e rv-
<br />...,
<br />r
<br />I vitt r --- Q (3)924 .7 4"
<br />Food Safety Certification
<br />Name:
<br />fa ...
<br />v4 0-71, 5 C 1 , ( c-A4 _
<br />Hand Sink:
<br />Facility Hot Water Temperature
<br />i 0 0
<br />Warewashing L Chlorine: D ppm Heat: 0
<br />Exp. Da : )3 /Q j Warewashing Sink: 0 F Quat. Amm.: ppm Other: .
<br />Received By / Title: ViiNCA,'Q--t('ZqUI--2— OCC) d US — I
<br />EH Specialist: e-C--t-roy tAi cNIL5 Phone: 14.... (3 R......._ 6 _s,3,_s
<br />Time in: Time Out: Page of
<br />El-ID 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION
|