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i(d5�2O3 <br /> "a"`" SAN JOAQUIN COU Y <br /> `x ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �/FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r S A1 r C rn 1 t K.�Date: 9-'12 <br /> Address: �L �r W,. A. City: D )1 Zip Code: '1 20 <br /> Owner/Operator: urrM-PZ+ 11 Telephone: 8/_ y <br /> Program Element: 0 <br /> 2 Program Rec O Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> y� <br /> "OBS ERVA`f'fONS ANDL©M <br /> 0 k-C ccsi <br /> ` �k 01 ha U Via V V_ h off' 61 <br /> C40 C c _mac-�-e C <br /> cA "r o I <br /> ra w 1 -sor a n-A c o <br /> Ay�o o m coo r .P,l Ck 5 Qeen,3 o r 6 kL4 Int. <br /> I D Ctoo r' e o o Ley- KA LA he.. Ll I f d r Lo W-e- r <br /> 're, 1,,s -Qnoy +o r-.e, O -FO on-I et..,p 6111 <br /> Y Cisbi L547ot --F 5 h eLtA L <br /> pnotj-4 at— 'jae <br /> -+ Y comp 151 e% l C <br /> /a5 Pq - CLacAj v�p <br /> LL <br /> Item/Location Temperature item/Location Temperature <br /> ...... -- ... <br /> r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine ppm Heat: of <br /> Exp.Date: Wareshir�g_Sink: / of Quat.Amm.: ppm Other: of <br /> Received By/Title: — t� <br /> EH Specialist: ^. L Phone: <br /> Time in: I,�1 T Time Out: J . '5 L,- Page of <br /> V <br /> EHD 16.24(2^^pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />