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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orci/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: / <br />ox C t1.0 10 / 1 e -F( LA-tk_ Date: //.... / 4 _ / I <br />Address: City: Zip Code: C2 '?")--si9 Ai (-'(,) i I c eirt Igal 5 49 Gl.bVL 4 os--- Owner/Operator: Telephone: <br />Program Element: Program Record: pe t.) s- -7 , 2_3// Inspection Type: -1,11 42 , <br />SB180 Posted es No Permit Posted es No 4-Inspection on or After: <br /> <br />,....._-, _ <br />-.OBSERVATIONS AND CORRECTIVE ACTIONS MEM <br />Cr, /e-a---cLyn-7 - C,i.4.7 1.-e <br />01,ti eV.-' /4901 69(44 a /Lek- (c k ci,,t ( , <br />0 vt.e._ kiut el( <br />i b 4-1/414-4 coicfreki 2, 0 7-- <br />1 s c-7---- , f,a-Li Pcii -c 163 <br />-1-e-i-- S)-1-1 p_s ni, s •t- <br />a go-a-dA CM--c' 36 D 1'1^ f---- .. <br />0 MN ea,< U 1 3 e., ,N) <br />0 icei 1-I' I cc L.44, 20 1,0 i)-(_____T u----c-,_ _. 7 i_a_A <br />Item/Location temperature 1111411111Wir Item / Location Temperature <br />11111PI5agty Certification ------lrility Hot Water Temperature It Warewashing <br />Name:avedi) <br />kin <br />. , ) , , /i kae-t,fle-i Hand Sink: 0 F Chlorine: ppm Heat: . <br />Exp. Date: 4/76% 240 2_2_ Warewashing Sink: o F Quat. Amm.: ppm Other: . <br />Received By / Title: (j, <br />7)A--- filen _S-- 7-4 z -7-0 6 <br />EH Specialist: Phone: 2q',? r3 7-ery <br />Time in: V Time Out: I /S7,1t1 Page o <br />FHD 16-24 (2", pg) 4130 3 FOOD PROGRAM OIR CONTINUATION