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SAN JOAQUIN COLO <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjciov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: .;-‘, co-w< e.....,t,/Z Date: i 2. —0 x....4 <br />Address: 3 5-s---t) it) w as avt. ws,, City: 5-, igo A4)fri Zip Code:1 c 249 S <br />Owner/Operator: Telephone( 1 qe -270 <br />Program Element: Program Record: <br />PAIC 04 5.-3 4 -7-1 ,' Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: - <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />'--i'-vkl-l-c7 ev-tel hae 74- <br />91- <br />A/,'?1,0_//-Atied,e_ , 'co vl'ole . <br />4.gst,o 57 /f0-taeric. • <br />6 4.}S/1-2 Nex-ti-Le 3 <br />7.-/?.- /..,e.e_ / 544, / <br />A. <br />k 62 /0 s's ,,,(4. 2e9/ e . e'li ce it,---t--1----t:74 .1-e-ir <br />a.A <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: o F Chlorine: ppm Heat: °F <br />Exp. Date: Warewashing Sink: 0 Quat. Arnm.: ppm Other: °F <br />Received By / Titl : , : t.)-- y <br />EH Specialist: Phone: .9s -3 0-9g. 1.1AV <br />Time in: <br />• <br />Time Out: Page of <br />: 1 ifri /Li 30 All <br />EHD 16-24 (2^, pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION