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SAN JOAQUIN COUNT <br />ENVIRONMENTAL HEALTH DEPArtTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.smov.orgiehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: ICIP.jj VAII1 G V-CLIVP Ak- rti-(-1 il t% \ Date: <br />Address:Ik <br /> <br />3\ City: <br /> <br />g MCA v\ii A\)--e. <br />Zip Code: <br />Owner/Operator:m \A 0 r-el c 1 ca td O\o Telephone: C.-A q) .... q 2-4..a. <br />Program Element: \ toc o Program Record:C 000 4 u 5D 2 Inspection Type: (cAVI p 1 a -0-14- <br />S6180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />0) 111 Onda- ic ..Q,1\11. n c vii- •12-kit'‘i- &01,AykeS -1-1-k,e Cci V-A ?Le S ofe <br />c.ex:Lect On 0 k km111 seCtsSCifni n . on 0 - V‘s corrtout-e_ <br />?120t C71-i ue i-E>c,Ict \, . 0 CA4n-1N 0 •cc2ri rg Of &Cm pLe c off <br />011 wv ecl . <br />Vord cr c Wti i r, c,i 12-ccAck '.f - 1-7) - eat- -fo-ocK in kAIY-- . Pi &Cuyikrx ute_ <br />vici,u-icz tuckek\i Jcp\\4 W 1 \A'il-\ 01 e_ 1, rt)citA,Q. On() 1.2ce TT <br />-tb-ocl <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: ,F Chlorine: ppm Heat: <br />Exp. Date: Warewashing Sink: . Ouat. Amm.: ppm Other: . <br />Received By / Title: <br />EH Specialist: Specialist: ...4 ilt Ir. <br />I <br />Phone: r)_cci 4L '7'3 4 zi-f=, <br />Time in: 1 1 .. ,x19 ,40' Time Out: il : (-2) Page (of i <br />EHD 16-24 (2'p g) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION