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GkwaAe_ 1-Nok c\-\ e. W \ 1Zti n cc\ g- +e_ <br />OA-) ek-lk <br />Received By! Title: / <br />EH Specialist: <br />Time in: g <br />Phone: :2_601 AtS —31 4 <br />Time Out: ID Page of <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />-k <br />Nr:eycya n 0+ <br />CV1 n a C cip.i si co-- an -hrflitS <br />5 (c(Ne., 19aolc '19 eanA.A-K cico ork <br />,91-5TE- 1)-\-02- Ozovnd _ <br />4- Pt uhn Le- cbrI-(410-) ..i‘kl 6e- dme --- -Rafe_ <br />Otc2- V v\o‘cAii C x-‘02-)(-1-- .1 r- <br />c5Y-- --vt> k CC\Ae- y--eAln \A" -Vt-r- __() 1 -1-- 0 _p-iret- <br />T--e e.0 ace -20) c,1 <br />\ <br />Facility Hot Water Temperature Food Safety Certification Warewashing <br />Hand Sink: Name: <br />Warewashing Sink: Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />PPm <br />PPm <br />Item/Location Temperature Item (Location Temperature <br />Heat: <br />Other: <br />C u \i-ect <br />c-0-e <br />SAN JOAQUIN COUI I <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.orcilehd <br /> <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: H 1L .'c( () Date: 'q/ VT <br />Address: ,--3 '" e -n o.v, -,,,, ,N1,40\_f City: LSGIC Zip Code: <br />Owner/Operator: IZIALA 1 ' \-A i rel 42 Telephone:C.116 ..._-143?) 6t t;1 <br />Program Element: Program Record: n2,0 ,q.,., 4 cAio 62 Cl <br />Inspection Type: p_cduk..h <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />EHD 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OR CONTINUATION