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SAN JOAQUIN COUOY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siclov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: p /1/4 coil- 4.4 pi cLic t.-- k &MM./11-5 <br />Date: <br />Address: <br />ri7Vg- cwt.. city: Zip Code: <br />3 <br />Owner/Operator: - <br />- MA'kilICI <br />Telephone: <br />Program Element: Program Record: <br />L1019 2- <br />Inspection Type:#4151:-..r ce.4 <br />SB180 Posted ifor No Permit Posted e No Re-Inspe ction on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 +V <br />\itrt% 0- 16 /1/ DM 111)C /1111(41_10 <br />)1-• tits ?c,ovv\4— leba‘J-Ae. <br />y- pre_feibte-Ar dioreevo. (A'a I crt1t-,1 a* Ili fi 1714,x, .„,j.s <br />* CAC- 4) fssy-t dove- 'r--0 I ci 4..s ingtiet, 6e.,. taltg pow.m.i- <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: Hand Sink: 0 F Chlorine: ppm Heat: °F <br />Exp. Date: Warewashing Sink: 0 Quat. Amm.: PPm Other: °F <br />Received By / Title: <br />EH Specialist: Phone: <br />-r2Get"r/&--- 7' <br />Time in:i . Time Out: u Li--; Page of <br />W lin ii,1Af <br />EHD 16-24 (2'p g) 4/3/13 FOOD PROGRAM OIR CONTINUATION