|
SAN JOAQUIN COL
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East Hazelton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orcilehd c,k9Aro-c.*
<br />LW-1— 00 1 /4-A2_ 64
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT Nortr\k-2e
<br />Name of Facility: Date: - 2
<br />.
<br />,..--1 ---- Address: ( Li s '\_ .k k (0,-1 V-tZk
<br />City: -k-Qr Zip Code:
<br />Owner/Operator: .-' Telephone:
<br />Program Element: ‘1/440 ".S lEek-1-"\-51"2-... Program Retord: t_iko (I Inspection Type:
<br />SB180 Posted Yes No Permit Posted Yes No Fl•Inspection on or After , ---) i ,_ _, e , k_v_16 '7
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
<br />k i.A.. .A. •:-__ • A • ...... . 1%4 era • • 11 vi C --1 /4:.j . Y ---- . \ < -r--
<br />-0-4._\ .".1-T•4/ \ . '.. Okr---0- C-19-Z., 1 1 e -
<br />f.,4-0--k._ pc"-i.k..... °I'-e-el- kNr‘j ck LI ,--1-51-7-7 \,e22v2--ct Ev-
<br />40
<br />—Co st---N r-
<br />E-"-0-v% AA Q6--e-z\s12_ -
<br />Nr....0.....* u...3c,je..-N. • EL? Q...v-42.P-c,4kr•- l'-v-* l 09.,egj p 4111 -v-r\p-c.fe_ \r.f,2 —c)
<br />VM•-14,913' V-\r-4c \•?%-t---4e-"- \ TO F C f\"--"-• (Y\-'-'-oe-N --Cr .._..a-NiN
<br />L "" 2 C.12.4,-, " i I ? A-A.Ar ,-9-z- C7\r"r4- r`-‘•/"-A- C-i' k C"5".-- Q__ ... ..) c.fi-
<br />kXells)_.4---)..e.-. -Aocl...j . Li1/4 I./Li--
<br />..Q\--c-f-:-n 'co
<br />si--4. 0..,-.0 kok------. 0—(--ck A\-Q-
<br />eN(0.9.2s1c.03,(sz 0„.._,c,c/r3c9-c... ckf--9_ <00F (2 ckkiN &•-z_c_510.---A--) -IS ..)
<br />iNN.,42 So.SIR t.S.N --k-\--42,20._ c2 c-a-A02-?.._ 0--, '.-k---)r- ‘e_3-' pi..„„..„..7c-
<br />
<br />- 42....,_,0,3-50 ()Jr T-A 1 f------ 6\. ko_..
<br />
<br />& -,..,rA C3Z-A s f---Q.-4- ckmt,`, \ 0,,L.S.sz 0,--
<br />5t9 ok-,-.."...r•N A-A-.2 e.c2,---z.A.pe--> i....o-e".. -..-0-kszA
<br />cl.cii, . h. Wo---Z. cy\--Ve.. sp-r,--p/co-e-a-z_ fr-- ,i-- .0Q
<br />--\--\-e- -1/4-our- 1 --V ,,,c9-9-eA c-0,---di 30 i
<br />(01 ---K--\--. C),A -Jr\--"zifISLA'te-% --0---4•1—, "'Y •-;21- f."--4- -CA et.D-A- p\11-412 fl
<br />_
<br />Item/Location Temperature Item / Location Temperature
<br />-2- A.0--,1-\_ ci-i‘re-,--- f-,1-3k- , (2.
<br />c.J.,...ic- --Y-cAt..) ‘1\izg-Na_s_.-4 ‘42;
<br />Food Safety Certification IF i Facility Hot Water Temperature II Warewashing
<br />Name: 1.1:11:4:s eci. 'Hand Sink: 'So .F Chlorine: ppm ; Heat: ' F
<br />Other: ' F Exp. Date: _ Warewashing Sink: . Quat. Amm.: p p m
<br />Received By / Title:
<br />EH Specialist: Phone: 4,6 9 _ 0 ,c) ci-Nr-4-\ 0 ,_ Time in: t t -. Time Out: viIi. ? ‹- Page of ..--._._ .....-,
<br />EHD 16-24 (2.,pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION
|