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SAN JOAQUIN COUNTY <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.orgiehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Date: //.--- /4 --• lf '1a.tfit4s., Name of Facility: <br />1" 1119 'd- , . R./ City: ddress: ---c'^c^c:2 p , 6{/1 i cpa."_ I : 4j <br />Program Element: Program Record: <br />ie . Zip Code: ef cia s,.... <br />Telephone: <br />PNR0 oro 4 '-9-& Inspection Type: 2— RovtAI , <br />SB180 Posted Yes No Permit Posted Yes Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />'t 1 D CV <br />i;--te_47 -gAA.,4,0 <br /> t' evi 1 F3:07 d 41,cifey t.i.•-•-W-1 deQ.-y-r <br />D pe,,,e,A / 4-, eddee--K- F Rovch- -1.-c- eitay <br />H-fsce.e/ '`? /eç de4/ 0,1414 0 i ' I W-e_de- ri <br />5i-e0-- kW, /Ye' p,,fae _. Ts,.---F--- _&62 e- <br />t clead..2?-cd& I. ismakig) 1 20t- . J3/ F . <br /> R:ioal ( e c---7--- YI9Lvt 6 f ‘ & 4 ,71- hated / ahvar i‘ <br />bafr17c I fr„ kii (A7-7,-- ,.___ --/aLu-e_. c1). i iA LA-4--e,v‘-c ; 1C <br />13,,,,4 c, a i . ..., . . , , A 3 ...1 64,--7,-...........4-- <br />d•-tgt.-.---- g# arie-Nr"--pi <br />5 4 eii_4n5--c 4 v ?,)-i-- _I. 1--e-fi }Ki"--m-i---14-6-4 <br />1 <br />2 0 <br />Temperature ' Item / Lo Io <br />..e t.).-t‘ - LS cf <br />Iemperature <br />(S Lt,e___ <br />food , „..Iii, , ' Facility Hot Water Temperature Warewashing <br />Name: HAL gefrte„cot, Hand Sink: .F Chlorine: ppm Heat: 0 <br />Exp. Date: to /2 1) / 4 ep 24) icti.oermtil,19/sk: °F Quat. Amm.: ppm Other: . <br />Received By / Title: :) 4 Vo5 <br />EH Specialist: AA 0 A/7„. (4.-_...i/ /..sr <br />Time in: /"--1-1"ime Out: <br />10: <br />/1 lytt Page of <br />tic , <br />EHD 16-24 (2'1 pg) 4/303 FOOD PROGRAM OIR CONTINUATION