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SAN JOAQUIN COUNT <br /> •.o� <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> �q..•y=,.�;;P Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.si4ov.org/ehd <br /> ,FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: —r 1)ALA 5 Date: <br /> Address: 1` y City: Zip Code: s C <br /> L 8 8" <br /> Owner/Operator: J Telephone: <br /> Program Element: Program Record: Inspection Type: ►�[�p 4.-AC <br /> ,n J <br /> S6180 Posted Yes _ No Permit Posted - Yes No Re-inspection on or After: <br /> '"Ic, C POBSERVATIONS AND CORRECTIVE ACTIONS <br /> a 1, _(.rvi S n -f C 0 r.,e d l <br /> re � �d ✓': in Q > <br /> 114 r. Ad 5 ' n K 1 S PC, fr 40G41P)5. 'rov:Ile awti <br /> d S and S ; da Cc, s <br /> P CA CA P ru W WooJd ui ; ah en M a ) <br /> le c4 r, IOUrl i n G► C Gt n e+s A e& cle Cl <br /> 5 4 roc .,n bC4 5 S •I--or <br /> o (4 . 5 s 4C <br /> 'I . n ! 15 C, C' ICP n <br /> LA.) e 0 JeS. <br /> Nei ty Wrr 9 n •f1 <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> I <br /> Tr 0 3cr <br /> Food.Safety Certification % Facility Hot Water Temperature Warewashing <br /> Name: V u 4hie D Hand Sink: 'F Chlorine: ppm Heat: o f <br /> 1 <br /> Exp.Date: 3 7-/q arewashing Sink: I-a� 'F Quat.Amm.: ppm Other: of <br /> Received By/Title: 111VA '7 <br /> EH Specialist: Phone: L <br /> J°1G'v <br /> ime in: <' Time Out: �� Page�of <br /> EHD 16-24 (2n°pg) 1/18/12) FOOD PROGRAM OIR CONTINUATION <br />