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and Sink: 1 00 °F Name: <br />(toy,E!FtAcati9,,,,_ <br />vglo3 <br />Exp. Date: 21 .21 <br />Chlorine: <br />12.c °F Warewashing Sink: <br />- %c,c) ii-01 Leir COOS GP Si --le <br />-.42/11 ( c fp c4- <br />Item/Location Temperature <br />1?7-e/i7 ¶1 <br />Temperature Item / Location <br />Facility Hot Water Temperatt.ffe <br />°F <br />Quat. Amm.: °F PPm <br />Warewashing <br />ppm Heat: <br />Other: <br />fc3-0).W OjCt<0_:12) Received By / Title: <br />Time in: ; <br />EHD 16-24 (2^, pg) 4/3/13 <br />Time Out: 11 Page( of <br />FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />-n-Vrre Dre c Witt \-n The fn rki Fcvnyve_ <br />ard r vit-nOr- C orrtrb I <br />01c-- sSAkt -r-P_AzAmk vr <br />SAN JOAQUIN COUN <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: -pu 12cA -I tri ,c 1.4\ ‘ m ey c u 41 il _1 \ ,4W-.1-u <br />Address: <br /> Date: 1 0 <br />at9 I 7 WI rn 0 \WON City: IA ZipS-- Code: Ci 35 <br />Owner/Operator: i0SCiik Vir Nela. <br />(0- (2.%)-1--1 <br />Telephonek6 _ liqA. <br />Program Element: Program Record: 1>g Inspection Type: <br />SB180 Posted /Yes 0 Hermit Posted / Yes 0 I Re-Inspection on or After: