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orauin..� SAN JOAQUIN COUNTY <br />a ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.. P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />4clkd'ay' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: -77 77,770177477 <br />Date: 14 Az-a-z? <br />Address;-7/ I City: Zip Code: Z <br />O L <br />wner/Operator: <br />Telephone: <br />Program Element: 2 Program Record: Li t� / D L <br />Inspection Type: P —j4L3 <br />6180 Posted Yes No Permit Posted Yes No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />a d <br />-F,a L4 b o- m <br />z- 611 <br />l 2o 2 3 ,� //ow u <br />4 v! ie SC � x a - Lr, �lk <br />/ <br />W4%� <br />ILnO \. <br />'� <br />! `5 00 ✓P CYm Soda, <br />{gyp --C •hA <br />e ! SC, -?o P! h a-- e -'A ' Gil <br />G/ � Pir Go Pfrli NGt 'o `on-? c n�r/n� <br />-6 t <br />—5-�/Pe <br />M <br />O <br />r6y Ok- 4e a / Ce em <br />Le— <br />41W/ <br />4 de O L2 Cup 4,f p <br />d 4-10 <br />6lw ✓e e 114^ ?Z4 6 <br />ld6,1 7 2 jkU <br />'l L t S n'88 <br />rw ✓e -CAi � <br />L ` <br />2� +c-6 1, a W1471Y1F+ vv�'t+ c (�Vb a C'� �0✓��0�✓1'Vi (/)� " Ovl- <br />- Item/Location' Temperature <br />Item / Location' I Temperature <br />Food Safety Certification Facility Hot Water Temperature <br />Warewashing <br />Name: Hand Sink: of Chlorine: <br />PPM Heat: of <br />Exp. Date: erewashing Sink: of fait Amm.:PPM <br />Other: of <br />Received By/ Title: $ S r� W (s� Sv d <br />EH Specialist: honer <br />ime In: i Z; M Time Out: 2 <br />2 2 Page o}Z <br />1tf <br />EHD 1624 (2° pg) W19 FOOD PROGRAM OIR CONTINUATION <br />