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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: '`: ' - ;\./A Date: („3.. 1 - 2 .__, <br />Address: k4C\ Sc, -c-:‘' <br />City: S...\....cy. 4_4\s‘tr_N Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: kv...:2 / ( tociogram Record: k.(.6/ .5 Inspection Type:,. ‘ is...*'‘‘r-12_, f -T t <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS tw,zz <br />) 0.—c--) -..._.mz._ — y--,.. ----- --,---p...Q.:0 5 -a - n v..„-..,, ,A ry-...p <br />V L._.1 <br />(6 NC7 -k."(N 7 \'.-La'Nt -1. t <br />LP- c1/4-^-,--"r•-i-Nr---e-4 .4 (,.os4-ct_ --r-p i <br />r--,... -f--S--er-‘ f xQ,..r23,-- <br />- <br />(";...\ )00%-iy. 0--<...e.--se• T co9-9-, <br />0.......Q.e...--,)ja 5 .ki ec-7.- cn: yv- <br />cQcJ e,,,,i, -5,--,1, <br />‘0 o\ )c DoWc:-, VNAe,\_„.-2_ --e c..,(5\--y-\, V.,:z_ <br />_I <br />ec fr• C \- --.---1(-\-'H(7)2 - 0 <br />0 "ke: (D ?o <br />‘ - - <br /> <br />1 V2- E <br />C \ — <br />- Q.)--- <br />Item/Location Temperature ......„ item / Location Temperature <br />' Sb F 4 <br /> <br />C-oo 41 re.".r) x r•-q_s:- iis. <br />- L4 LA r <br />,. C-c>of 40(10 ‘.-A 3 1---- 2.1Z.F: <br />-'( 1— a.13—g-- aid& , . \ c cia,"...\00,-,s 4-nr,66L9 <br />c•-• (7 .- <br />.....__Q52,,,, c <br />Food Safety Certification Facility Hot Water Temperature <br />1 Warewashing <br />Name: Hand Sink: .F Chlorine: ppm Heat: <br />Other: <br />°F <br />Exp. Date: Warewashing Sink: . Quat. Amm.: ppm °F <br />Received By / Title: no <br />EH Specialis c,-..k (r.- ‘'Th-S-2 <br />Phone: 2_0)c:of _ b b_ <br />Time in: Time Out: Out: Page of <- <br />Z.- ) --........ <br />EHD 16-24 (2" pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION