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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.sigov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 14/ az...dovi, Pk—, 1, U C. <br />Date: iliAc/019 <br />Address: 35- ,s--0 Ai / LAI-A/City: 7coto exam.; Zip Code: <br />Owner/Operator: Telephone: <br />Program Element: j (y. Program Record: - iz, 05 3 s a c Inspection Type: go it.riir <br />SB180 Poste c No Permit Posted No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />P r, Y; fi9 9 ) <br /> Via 1._ A -124c24N.- __#N) <br />40‹ / to $er -7.--/ 6W Icgle) .0 /el— A/ 0 v - - , 1.P-4 1 /4//166 <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: o F Chlorine: ppm Heat: °F <br />Exp. Date: Kv.......---- Warewashing Sink: . Quat. Amm.: p p m Other: °F <br />Received By / Title: <br />EH Specialist: <br />"4--Vilf <br />Phone: ...2409 .54 / <br />Time in: Time Out: Page/of / <br />FOOD PROGRAM OIR CONTINUATION EI-10 16-24 (2^, pg) 4/3/13