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,op4 .�oG SAN JOAQUIN COUNTY <br /> Q` Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 9CiFOF<� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: PyCi. _ C' \O\ e Date: 4S7—21 _Z.. <br /> ddress: F1 \—I <br /> , 1 City: 1 Zip Code: C:�11 2 <br /> Owner/Operator: AA - ; VT- e\ Tl Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> 58180 Posted Yes No Permit Posted Yes No vV V Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Y_L- -_P_ck 11 <br /> _tt-C S S� <br /> C <br /> d mrd . <br /> 3 '\ a. \ zQ, , pruv— Az) <br /> r' cJ,-x <br /> O e c � <br /> -\ w u l e i <br /> 0 c>x 1 S c,\_n \.� <br /> r<\ k r(\e-\&I <br /> ItemlCocation Temperature Item/Location'-- Temperatures <br /> — <br /> 3�3 <br /> nDate: <br /> SafetyCertigca;ion Facility Hot Water Temperature - - Warewashinge e 'Hand Sink: 12� of Chlorine: PPMHeat: of <br /> arewashing Sink: Z-C) of Quat.Amm.: PPM Other: -F <br /> Received By/Title: _ <br /> EH Specialist: Phone: <br /> Time in: Y Wv_� Time Out: q ; Page, of <br /> EHD 1&24 (2n°pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />