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SAN .JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />• �a., z �;; Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: _ Y Q71 <br />Date: <br />Address: 2_2( l Df-iF�,;Y <br />City: �D y Zip Code: <br />Owner/Operator: !i P-Ak R �^ <br />(1 <br />Telephone: <br />_2 3 Z 3 <br />Program Element: 0 Program Record: 57ke <br />0 <br />3c-)3 Inspection Type: <br />Lft <br />6180 Posted­� No Permit Posted <br />Re -Inspection on or After: <br />F: ;- • OBSERVATIONS AND CORRECTIVE ACTIONS <br />,. <br />�,l c�p/'"f o �g t�' /•�-ND /41'� Q TDL.�L c� � 5 f�u�5F RS . f} 2E �wl��S <br />G / m me D /arm•-�i <br />p srm,< 4 5 4e A/V TI S �o�v DF ICE , IN i *4./- <br />f3�iNIC REUENi�oKJ �v�CE //U C !vim � <br />MW_j_ Ar ri616 kgoPk- 100N- 16iovr FQ nye C7o3kFr i' <br />Hr' -S -IV e"Oove r] L w r` IPT5 41 rT'rt <br />RADIUS rr7 r� c. <br />y fvb wOsd 5e&A),5 rrou Te-& owr anw5 NuririDIisj ,S"5 (ul--fE,t>t TEL <br />[.vive-k % -Take 7) 00-r Mow ST <br />&woiq), J ( n W NE'W O W Al w.C� <br />I ( TSL <br />6 f� 7'0 (55u< R rw rr PRS PW"66Z CV) 4r <br />SU PJ_tFS rW 3tAti- ,46 ANb SEEw+5 tPfpk <br />kemlLocation Tgmperature 21 Item / Location Temperature <br />Item / Location Temperature <br />Food Safety Certification _ Facility Hot Water Temperature Warewashing <br />Name: �. Hand Sink: / �/�F <br />Exp. Date: arewashing Sink: ' <br />Chlorine: ppm <br />Heat: of <br />Other: of <br />uat. Amm.: ppm <br />Received By /Title: <br />EH Specialist: <br />h ne: _3 <br />Time in: <br />Time Out: /0:0c) Page/of <br />EHD 16-23 (21' pg) 07129/09 l I v FOOD PROGRAM OR CONTINUATION <br />