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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.siaov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: �'��C P At, AA 5 1; 20 Date: ()1 — <br />Address: 0 t7 2 ` W A -t-6e-LOQ City: STQ C �� Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: 6 1 Program Record: <br />O <br />Inspection Type: <br />B18O Posteda No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(V O p A- V 1 t7 L-19 i to rJ $ , <br />I• •1J►ADC1MuM 11 0fATEk WAS 1-% ,\lI <br />ifM1i M M C <br />i. o \) t.>:�AM <br />N <br />wq,$f+ sIN 6pA1?_ Wir IN <br />`iy6 faYS. <br />5't i 6 GACKLOCA. <br />FROAPC W 7 <br />V€ -n Atj kjtjcL;gnoo <br />su <br />rAQIZ $�51 D E W Ai?,E WX15 <br />5► k • L- <br />G� � b <br />ovation <br />3 ;F <br />-- diem/L n- ,;Tem pre <br />Food Safety Certificati <br />Facility Hot Water Temperature_ <br />Warewashing <br />Name: <br />Hand Sink: 'F <br />hiorine: PPM <br />Heat: eF <br />Exp. Date <br />Warewashing Sink:'F <br />Oust. Amm.: PPM <br />Other: 'F <br />eceived By/ Title: <br />Specialist: `r t- A u t -k- vL a j -2-P Phone: 209— 5c / 3 <br />[EH <br />^, Ov P Paga �oZ <br />ime in: { I 1 AM Time out: I?-.- <br />EHD 16-24 (2m Pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />Y. <br />