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SAN JOAQUIN COL 1' <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orgiehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:5,, c <br />—1 <br />,, <br />Lc Date: r Z/ R 76, I .(„1 <br />Address: <br />---• 3-S0 i \i'\ 1 MI City: Zip Code: <br />Owner/Operator: <br />1 -keV r-' .ç I k" <br />Telephone: • 277 -oss, <br />Program Element: k 1:3 —53 Program Record: .---- Inspection Type: .Kek , 1 <br />v l.,tri/ .--g..0 c----- O <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 1 c c 1- <br />OBSERVATIONS AND CORRECTIVE ACTIONS I.0 4 <br />' (i) . ----),_ <br />-F7,04 a e r / Ca I&C 't tik ,5 <br />..40 cl elys <br />0 Ok ( <br />o r e `NZ_ -C.- 3 — c0---AA- <br />4 1 <br />. k i, A IP 41110 411. i J 12.- r ,• r . • <br />P r 1 0 (fa .. .k,c 60 C k.) -Q r - <br />lel <br />c 0 c tryl. <br />0 Fet I „re, \it , _t_. ‘...t.. .,N. , re iks e / .1.)v, pz IA- I i A i <br />0 lAj 1 X) C ( Se I buc 4---. <br />C ne -4/14 2P,fr <br />t <br />- C C a 're' fe.r I • e .F <br />CA.k aSe--- 4 a I 01 <br />t , 0 0 -- L :AI ii 41° # A 1 . eb AV Pirarle. A <br />, <br />612)(\ Iti_. ° A A - <br />() ' ....c. ----> c .., 91 <br />, _ 6 <br />em/Location Temperature <br />?____. C 00 t-e. r <br />Food Safety Certification el Facility Hot Water Temperature Warewashing <br />Name: lli 16,-- <br /> <br />iv 4 , i IA. tk...11(.._\ (2 nd Sink: o F Chlorine: ppm Heat: °F <br />Exp. Date: k 1 '7(-_-) Wrewashing Sink: .F Quat. Amm.: ppm Other: °F <br />Received By / Title: .,-----7 <br />7. - <br />EH Specialist: 6) Phone: inar v• ,..... 03:3/ V <br />Time in: <br />IP-, 0 -- Time Out: LE Z ip j1 r) . L-• i'''' Page <br />EHD 16-24 (2^, pg) 4/3/13 <br /> <br />I FOOD PROGRAM OIR CONTINUATION"'