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SAN JOAQUIN COUN. <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: KCCS CA a q c a o a Date: /L... l b _ 1 / <br />Address: 3"--62 Az (AANt. ye/IA- iA.Jety City:,5,., kc joinit Zip Code: q <br />Owner/Operator: Telephone: <br />Program Element: Program Record: pe0 5 0 4 q-D Inspection Type: g2224A A_ e..— <br />S B1 8 0 Posted Yes No Permit Posted Yes No Re-Inspection on or After: ....- <br />OBSERVATIONS AND CORRECTIVE ACTIONS • <br />)4..s7 1 50 <br />aot,,,,zza-v cast-vei -02-ga. ,(;.‘ <br />$ .7) <br />/ 5 i-t)Irs <br />g( ( 'f-S71=24"i/ ell7 44)4- /- 7 L - 6) - e r / 1 3 c-c- <br />N v 1---(jv -Dy IA 0 ic,L.,4avi <br />, . Ste " 4 I 'r <br />— dpm.- ar% 0 i <br />Item/Location Temperature Item / Location Temperature <br />Food Safety qiiition Facility Hot Water Temperature Warewashinp <br />Name: <br />M it) h V /-- Ulk Hand Sink: <br />Warewashing <br />oF Chlorine: ppm Heat: 'F <br />Exp. Date: 1 r I 11 1 2 € 2 ' <br />Sink: . Quat. Amm.: p p m Other: °F <br />Received By / Title: .....___it IA ..k..) ITC)-(__q .i._.__e:y_. _ <br />EH Specialist: Phone: <br />..± e l ...F. .. ... 1 / 5 57-‘9i Time in: Time Out: Page of <br />"JIM 12-130 io it4 12 i / c' <br />[HO 16-24 (20 pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION