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ota�ln. SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www sioov org/ehd <br /> �IFdR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: cer 1A4 le I. Date: <br /> ro <br /> ddress: city: Trac Zip Code: 953 ;.A <br /> Owner/Operator:s• i r 1 W L T^ L Telephone: <br /> Program Element: 16 U U Program Record: C O O L 3 5 y z Inspection Type: C GM <br /> 5—iI Posted ❑Yes G No Permit Posted C Yes n No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o Un 9 /1 5iie bc • 'hJ i,:CILP.t <br /> Ctnd r � ti. 3 1 0 2 <br /> at o ItoM { h h:CICPn rr)e llt / �hc <br /> L WCl.5 Out 01 le - <br /> 5; }c � 6 All }tn't a t AI forts certr O se.✓l r,/ <br /> Ont .� o rl W:#► ex ;rt/ rsf h dr. 4es <br /> o � O ! n CA ;GICP„ cs rtra : ves oto <br /> ata i n a -; and 41.an I� l f� on .s /u <br /> GIt GICen ac Ka has no os ' <br /> prod Acilil receilr I t <br /> r w d Grot # ce a Wfefa �l r <br /> aS h0.1 QUIGre O cc/n rtltj - //el,c .5 <br /> SIG NJ G b ere C4 ON ! YYIG(ie <br /> CICr., 0 or1 / 010 i ro, U) .1 ✓t <br /> temlLocation: ` Temperature Item I Location Temperature Item I Location Temperature <br /> Aif (J,Jq -•n '/4/ i _ + l .:� -. n CII I- I / __- _ _ (1.:,, <br /> ctrl lLtn S 14 7 / r V <br /> Food Safety Certification - •Facility Hot Water TemperaturqF <br /> Warewashing <br /> Name: Hand Sink: Chlorine: ppm Heat: <br /> Exp.Date: arewashing Sink: uat.Amm.: - - ppm Other: -F <br /> Received By I Title: <br /> EH Specialist: hone: L <br /> Time in: Time Out: Page, of <br /> EHD 1624 (2n°pg) 413/12 FOOD PROGRAM OIR CONTINUATION <br />