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SAN JOAQUIN COUr Y <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 /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 1 j/A / d-/ iv, ,, L/ ,, l., k" \ 4, Date: <br />3-yC s- <br /> <br />v s_,..,-- r , I.. <br />Address: l '-...,,, I City: Zip Code: <br />Owner/Operator: via v_4 <br />- -L-rriAAA <br />Telephone: <br /> <br />R 4- <br />Program Element: i (I? 3 ci rogram Record: 6 go pact Inspection Type:7 tivrinie <br />SB180 Posted Permit Posted Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />['c t <br />0 d— Ar( /1/Me- ----vv\- )4.---Airf- <br />vf--.. 1971,,L=4.4,, a,7z-- F 01_ <br />(P <br />in ( 44/14. /17 Nene-N. /Y e/ ("4 '..-41..rLd Y1,-- <br />1 Viot'el- AitC,Q14/+- -.A-1/(4111,:e. 4- I .._..../ <br />117 kS- , <br />4 , I <br />item/Location Temperature Item / Location Temperature <br />)( /141- i AAP W. - ,&ii) q if; 1.4-----Ue4"--1. / ' <br />, <br />od Safety Certification , Facility Hot Water Temperature Warewashing <br />Name: ti Ca jl.land Sink: <br />/6 i <br />.F Chlorine: pp, Heat: . <br />Exp. Datet i AO 1W arewashing Sink: ? . Quat. Amm.: ppm Other: <br />Received By / T/itle. r <br />1...)...... I 'r 1- 'L- <br />EH Specialist: i .4 All _ AO. <br />Phone: V 4;i - <br />Time in: Ar I Time Out: Page -)of <br />,..- <br />EHD 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION