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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: [36 �� �� >(� TA �� �- <br />Date: —2 <br />Address: :319 3 W III—SON Wfl Clty. <br />O Zip Code: 9'S 05 <br />Owner/Operator: r�N A FAD � W._ 1 -� <br />�V <br />FA?mProgram <br />Telephone: <br />Element: 1 O2_q Program Record: P <br />Inspection Type: <br />8180 Posted VY as No Permit Posted Yes No <br />Re -Inspection on or After: <br />BSERVATIONS AND CORRECTIVE , TIONS <br />N M. A TO PL O L.A "T l rl CO U-4 51 Q" <br />M A3"0?-- 2. - A. C .-- $SrqLVIW tirt I t_D <br />AND D19 IN WA l <br />CtLl 1$ 2. <br />1✓OOP AND F6112.5'014RL <br />x Non/- FOQLb <br />kiWPLE-95IN -rA49 K <br />Amo #00P 59vic - coli <br />sl <br />— rood) M <br />.0 coo AMD <br />N <br />-rb 6 L-ACV <br />p Ip 51P1 f e -D p -bo b <br />V T <br />IW 69 <br />N w S on 1 <br />Lr <br />p,F <br />ji,AStbrr,T A L.Er& <br />=LD Q'& E <br />tiI Fou R. 9_5 ►I= <br />LprAawiz MA A IJ <br />bv(L VA dy R.5 b 15 G iq 9--o Foop1 <br />MVI, <br />o0W X . <br />I —tion !�EMrjpre - - <br />t Locatlo <br />rot -Doo t)& — F ROW 9 141 <br />5"r 2- <br />Z — Dao 2 'PRS C OL.6i2 -✓ 9 fr- <br />Food Safety Certification <br />17 Facillty, Hot. Water Temperature <br />aching- <br />Chlorine: 100 ppm Heat: 'F <br />Name: <br />Hand Sink: � O aF <br />Exp. Date: <br />arewashing Sink: 12 "F <br />oust. Amm.: ppm ther: "F <br />Received By/ Title: <br />EH Specialist: A u l t 0?_0 Phone: <br />7t <br />ime in: � I : t j5 A MV`�/ Time Out: t4 1 1, M Page of <br />EHD 16-24 (2°` pg) 413,13 FOOD PROGRAM OIR CONTINUATION <br />