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Received By! Title: <br />EH Specialist: <br />Time in: 10. <br />EHD 16-24 (2,,d pg) 4/3/13 <br />SAN JOAQUIN C0100 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 1,Aa(ACIC ipp cuctuCe.. .4 t) f".. 11,121 1 1-- Q St/ina() Date: <br />Address: ‘12.zacto gi— <br />City: SAD c.,;(A-FAsi Zip Code: CO2.0(140 <br />Owner/Operator: ._ \ualj MCLC.A C4.S Telephone:czo r A F-y 324 <br />Program Element: 1 V 0.7 Program Record: no,7.6 2,0 4512.00--K5-03 Inspection Type: eCTISAtilati OIJ - <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />eisd CM rLf/fcai C UVISU Writh OTI <br />14 1-(ofci <br />n 4A-n-h Z.Ixtxtt e Je,6-y t s C-e0A-4 44-- kri <br />!qv Rap fic)-taiicsvu O2 cmutei <br />-67 I `›C Lk e, PeA.Aeri g9-#1 / fe_ <br />FE /636 .le c 470/ <br />Item/Location Temperature Item / Location Temperature <br />Facility Hot Water Temperature Warewashing <br />Hand Sink: °F Chlorine: PPm Heat: <br />Warewashing Sink: Ouat. Amm.: PPm <br />Other: 0 <br />Food Safety Certification <br />Name: <br />Exp. Date: <br />Phone' 2-6164 — <br />Time Out: Page <br />FOOD PROGRAM OIR CONTINUATION