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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.sjqov.orq/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: \ k 61\jr: i(s.A-- VS,..",- .(...g 1) Date: (0— t ---1.....--L-6 ----4:7•J•-,0C--Q.A...2 R , , :
<br />Address: k \ ...., i ,....\0,... or City: k....,0 JAN Zip Code: Gt s c.....,)
<br />Owner/Operator: N Telephone:
<br />Program Element\ toy) 2._ / ( ifociPligram Record: .5 ...k ko -119 / Ltk43 ,-,1.- 2._. Inspection Type: (2.,..A.....44--..Q / I c,.
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS 1"1"11.111111.1111
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<br />tem/Location- Ternparature Item / Location
<br />Facility Hot Water Temperature Warewasharl"1"
<br />Name: Hand Sink: o F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: .F Quat. Amm.: ppm Other: °F
<br />Received By / Title: ' I.A.,k v,,,,
<br />EH Specialis c,r).q:,,....N.Nr..... kov.....0.2 Phone: Locl _ to t b _ 33 -2___s--
<br />Time in: Time Out: Page of
<br />END 16-24 (2^, pg) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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