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SAN JOAQUIN CO TY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��.. ;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: kcaF-04 0.Q/(- •� ,IVA Date: q I2— <br /> Address: Vrfje Q N" City: F_ Zip Code: n-' 6 <br /> -470 .L Owner/Operator: CJ 1 Ml � od Q Telephone:�, _1i�'10� <br /> Program Element: f�r_�1� Program Record:: f 2 7 3 Inspection Type: -0- ^ 9_Nn,,� <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: ,1 <br /> OBSErRVATIONSA�D CORRECTIVE ACTIONS <br /> L ova QAk C <br /> 0e , wuS ern f <br /> -- <br /> *XO <br /> - <br /> 3 <br /> i s C.0- !--7-1 61F- cm - a . <br /> tue - <br /> O�7 1 r� <br /> --Cvil-F gmM4t;ca-' - EM -ee SVel,, O-Ne- eQ- vJil <br /> O�Nojv\a< wit IQ. jy�o <br /> _a <br /> cQ, <br /> t'em'C ocation ----- -- Temperature item. Location <br /> I <br /> A. <br /> Fcd 5ajt ty ertiticatiort Fa pity Hot water'-Temper` Warewashing <br /> Name: kHand Sink: oFChlorine: PPm 'Heat: °F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: `F <br /> Received By/Title: / <br /> EH Specialist: Phone: 0imCOG_3 <br /> Time in: ! ,) 36 Time Out: <br /> EHD 16-24 (2ntl pg) 4313 V FOOD PROGRAM OIR CONTINUATION <br />