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t, <br />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.orWehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:(j fl t , I 4 Vi 0 Cd .{-11,10.-nek HI (iit77 --- Date: Tg I074 <br />ddress:0(0) 4 9. City: ,...1-1tyllt) tj Zip Code: or • <br />Owner/Operator: a ‘ Telephone: sl'3.._1(10-2..._ <br />-Ac:_--q Program Element: ...4- rogram Record: w 4. pRD) Lo ocorspection Type: 411.vall- V <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />' OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 iA flli yi orz -pi'ucitAck? <br />P Ok\Mil-W— 0 SKI 11 A, 6--- tt Ch p 0 S.e, — Da I INI <br />v4c4 &KAI no 5Anwitn5_ p <br />(yRoa.:,(c pp ativice tt- FAA area rt iritr-e-416.- <br />tY)--' 3-g)12 <br />Pte VI itiriCkWA Arl --t) 1 bp--ib -A (51A% <br />afrighWA\I Th pizio ac_tzip a &filo-1M -011 (C <br />nu stiVIT Ifli, <br />&IN -67,2,11aN. loLuvfl12A-. pi5 2,1;)ti oritgrot enki <br />\-)) sArilictileNt) : <br />kiptitic6nc loluirrwA- c) .- PrJ2194( 01 <br />pKeftl c <br />t ABRIMFM7dVA, Dix A xlor on t • n ski <br />m/Location Temperature Item! Location <br />' <br />Food Safety Certification Facility Hot Water Temperature Warewashing , <br />. Name: Hand Sink: .F Chlorine: ppm <br />Quat Amm • ppm <br />Heat: <br />Other: Exp. Date: Warewashing Sink: 0p . <br />Received By / Title. A <br />EH Specialist: R al L Phone: 90C-1, tap .....13 04(1) <br />Time in: Al, a kri Time Out: <br />t -0 Page of elf, <br />OOD PROGRAM OIR CONTINUATION END 16-24 (2", pg) 4/3/13 FRolvolttio