|
:•C
<br />SAN JOAQUIN COUNTY
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 -9- 9- 0 -2,
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siciov.orgiehd
<br />1 0 0,j
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT b -t
<br />
<br />Name of Facility:=.,.------ Ct'.. -7\-----c..--..e,:„ \si \ jcz_i — ---k I c,,., ( L.,,,, Date:2:-S _ 2 ----4..„_2 :1,_, --, \ . ,..:(s.:
<br />Address: ..c._ C.\ -1_--A-) City:-- , Zfip Code:
<br />‘,..__\.-__(---". v 4- ,•----- k I c,-, c..y
<br />Owner/Operator: c-*: .75-- c -i--,"-- \ Telephone:
<br />Program Element: \ k,oto -42.1 to tptam Record: 2..) t / 7,s 0 Li 0 Inspection TyPe:S.c .‘''t--4 / 1 cc
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />: OBSERVATIONS AND CORRECTIVE ACTIONS
<br />...
<br />‘ \ ) .1, \ 42 ,.....KA 7:‘ J.
<br />,
<br /> , -2,
<br />CL, ie- \j",--;:% -0‹.?: f*N.9---CA
<br />.... -
<br />...........\
<br />f.Z.,) C V''' L- c) if 1,:.) CIA,J, ( 0., C -17--
<br />Q.Q4,-/2... c).--Q-,-(2-(2_,2-A-----c. ( r•--Q_ (.2,4-, )-42--c-_,.z -, n( ) \
<br />f -Q *. (,)". k - `A.4-r ? C- C., 1/4,. 1) v'l- \ . \242,
<br />J ) 1(i'Z'') ScfreCt ---17_12,43
<br />,,----N\
<br />) 7L—Lk keor \ \---0\--rf--12 C Ic'' JL, ,
<br />N.st_g dk S - -12Q;\ \--k\JU
<br />Or 0.1eN .5.0-2. c \----Q....? c -1.1--2., s +.0-1--€ --C r ...--‘ j ../
<br />C \
<br />r --E-- '1/4." Se.,,.,,cr-r ( `,'ime- \i"....Q,""._"1 /4 C"."\- t J-/?) C _Si!? 'S--k-bl-Q.. c _:, r•-0.
<br />) J -I
<br />Q-sz't 00,-St-r-rN ci% C-CA-1•-er-2.- C F /•-,1 .__Lr
<br />C \---0..---\,..' -9-z/ SA-0,r_e 4:: ( \_. , C\---
<br />----G
<br />Item/Location Temperature Item I Location Temperature
<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: .F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: cf Quat. Amm.: ppm Other: °F
<br />Received By! Title:
<br />3c41.— latiji
<br />Phone: 2_139 EH Specialist• N4 __, V. \ ov.......92„ 1/4...cw,c7,..1 t
<br />Time in: --1 , S :_S (......., Time Out: 9 ,. s Sci Page: of Li
<br />i
<br />FOOD PROGRAM OR CONTINUATI EHD 16-24 (2nd pg) 4/3/13
<br />2-U9 - •Ji(-YS
|