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SAN JOAQUIN COUK <br /> �a ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq. iP Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> • <br /> �%FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L pig Y CC-CY.Te,�I S L` V� Date: Vv3y <br /> 1 <br /> Address: (- Cul 6Mck City: CKV11-4 Zip Code: CS2U'-3 <br /> Owner/Operator: 3oW vc1ptn Telephone: U' — A <br /> Program Element: v;r7) Program Record: ' ":I— Inspection Type: <br /> 8180 Posted es ❑ Permit Posted Yes ❑ 1 Re-Inspection on or After: 'A ee <br /> OBSERVATIONS AND CORRECTIVE ACTIONS lot <br /> 'fo " oncxWws. u,4-"fi(c*e ey �(:rd - 'YRw W U neAv CTxe- <br /> (oma da s. 14 ot c%ii ees bcAj e -Fvoc )nanciLa-f <br /> C Urdc, <br /> �0 CU I i CG'PT T_N CA Irte PcviefCs [P-OK <br /> nAA Sic t o-F i W-1 , fU 61 S C N`I"+;n G -Fdcd- ( ( &C <br /> cNA-i- si of 1he IV-ck%W_4_. cpq cc)j'cn <br /> -VopCa i7 cWl� CAnAVICLe cKe CaiLe-,c <br /> Cil NU CCo\0n i CN^,j66 clm:A C11\ mu � <br /> �.e 6oDe 1hsC,\.P_ -'Chi TFc1( (pif. <br /> 5 0-f V\j rr=toS tans- <br /> c(i c-w_ ct <br /> 'C'f ltac:60­1 1S -Cbplc <br /> �vic�LS ;� cr-1 vn - <br /> ' 3��.:, <br /> �...�,. „ wW...lti+. •..,,.i:,t .i;',�iv�&aml�r �+s�2�vu' "`; ,�laerii'x �a��r. <br /> Food Safety Certification Facility Hot Water Temperature �, �� �? - <br /> Name: it 1L� t 1��� Hand Sink: C�G of (Chlorine: fal ppm Heat: <F <br /> Exp.Date: 1 `� j / I arewashing Sink: I7 /, of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: _ -,)L� <br /> "rime in: IV �� Time Out: U Pager of r <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION. <br />