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Telephone:Owner/Operator: <br />Program Element: <br />Permit PostedSB180 Posted <br />4 <br /> <br />4?1 tft/e/uwv cAiaV <br />^2Avwzj-'l/v-s <br />^aA <br />~evH/vt*~ <br /> 0^ <br /> <br /> <br />Vi'a-ik>- <br />tyv <br />•<W\^S\ utAc^ <br />! Temperature TemperatureItem / LocationItem/Location <br />Food Safety Certification <br />Name:°FPPm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:F PPm <br />Received By/Title: <br />Phone: <br />fAVA <br />(Sul <br />- <br />Azyt A <br /> <br /> <br />a IcTF <br />|(X> <br />„ (^s <br />Z- lUQ'Vc <br />c <br />Warewashing <br />Heat: <br />Ucy S <br /> <br />°F <br />r~ <br />Chlorine: <br />Ab-Vr. T <br />Vv«V<. <br />T;y- <br />L ■ Y_ - <br />U-q/aL vyv^W^. <br />____CA V____ <br />~ V 4<a\^ XcKS <br />-Ok________ <br />Page, of <br />FOOD PROGRAM OIR CONTINUATION <br />Inspection TyP®:?^^ <br />Re-Inspection on or After: <br />r <br />Facility Hot Water Temperature <br />Hand Sink: op <br />_ o <br />V <br />Sav«.VQv»v\ <br />Time Qut: <br />San Joaquin Col / <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd <br />yy^.i^vLWw. <br />LW <br />Time in: ~ . /ri 6wv^ <br />E HD 16-24 (2nd pg) 4/3/13 <br /><rWVA^Vw^Vw> V <br />” Cc<^\o' <br />Ley <br />- <br />X- <br />'V'f^axfT 1 <br />_____________Food Program Official Inspection Report <br />Name of Facility: Cy^ Date: <br />Address: City: Code: <br />Tlj lie^'itcrk.Ar^r- CJ <br />!6^r Program Record: <br />Yes No Permit Posted Yes No <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cLy^S =• <br />ci____ <br />H \ \ < <br />w lYA La <br />__^A. <br />Ca <br />city: <br /> <br />,____ri -tx TVv< coo\€^ , <br /> <br /> ~~ /facVc) Hr b <br />py-c--" Ccc/V^A- <br /> Sava\ Xte'x