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a"'"• SAN JOAQUIN COUNTY <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.c.., `P.. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siciov.orolehd <br /> 9C%F(S•R� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -Tom 5 AA A KIII Date:a-2__ OZ - 2_3 <br /> ddress: City: Zip Code: <br /> weer/Operator: Telephone: <br /> rogram Element: 61 Program Record: ROI Co 9 o Z Inspection Type: 17,0UTi <br /> 8180 Posted 0 ❑ Remit Posted ❑Yes ❑ I Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> N 10 ATj oNS. <br /> A A C I A L I III (COVINE <br /> cOY 0 I 1 Fi r.AT-6SZY4 OV- OiZ a wivrAid 21 AYS <br /> st1E pgAep CDOLei? as Ar N . A 1-r To MAIN rA -4tF01Z <br /> Eu-5 LT TD17A . YRIir15 1 5 41 >✓fJ M T rJ L <br /> FAcILXTY DID NUt jjAY6 5LAOITITINK 5 wM014 B0C IGl✓ <br /> 9u T 1-rl Iloprepa cwLnKimr- ;-Ar4j-T%7_rNI <br /> AJIIpIN Or- Da.b <br /> fZF C C <br /> TEST I tnS 1%P S rJ o 1p k II I - N 19 5 <br /> W 11-N 1 fJ h A S <br /> d� IPItJ�t C Wfa <br /> l�ttJ C l>b15 I N31b� h ZI/V VTl N g 1 <br /> rc <br /> L -D.5 6 <br /> SE2 IHo t- DE ITN T E n 5 . <br /> ItemlLpcation Temperature item/Location Temperature <br /> A1.1.4�Y1- JODft WiI lrJ - <br /> F12EP-COnLAW- L4 4:f <br /> b_e,t,t wAL,t< -Id 3-6F- - <br /> MEAT_/bEL-I cA6-e I I F <br /> Food Safety Certification I Facility Hot Water Temperature Warewashing <br /> Name: W E6 bE L> Hand Sink: 1 DO -F Chlorine: ppm Heat: `F <br /> Exp.DateF lWarewashing Sink: �2 ,3 -F Quat Amm.: ppm then. '.F <br /> I <br /> ceived By I Title: 1 Specialist: C C t Phone: Zo S i - 9 23 in: D . 6 A mAr A4 LA I�LO Time Out: �/ 2� O Pag�of <br /> EHD 1624 (2n0 pg) 413!13 , FOOD PROGRAM OR CONTINUATION <br />