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wws? <br />/■i <br />No <br />TemperatureItem / LocationItem/Location <br />Food Safety Certification <br />FName: <br />Other:Quat. Amm.:Exp. Date:F ppm <br />Phone: <br />Time Out: <br />Hand Sink: <br />Warewashing Sink: <br />Facility Hot Water Temperature ___ <br />Chlorine: <br />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.siqov.org/ehci <br />)3CF> <br />zzs <br />Name of Facility: <br />Address: <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Program Record: <br />Permit Posted <br />_____________’ a*'Z/ < <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />5^ <br />Yes No <br />°F <br />,TIONS AND CORRECTIVE ACTIONSA, <br />Page of <br />ii&i <br />y—; <br />EHD 16-24 (2nd pg) 4/3/13 <br />ID ' ______________ <br />Warewashing <br />ppm |He«^ <br />V-U$(dVt ------ <br />y\£-A- <br />1 7-------7---------- <br />(00 — I 0 > <br />Temperature <br />Food Program Official Inspection Report <br />n^. Cily: Tz,iPHOde: <br />Owner/Operator: / Telephone: <br />Program Element: Program Record: - |nspection Type: " <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: / <br />OBS^RVA,! <br />3 c—-p <br />jo! F <br />'r^— <br />/\)& (a.< B H-t tA i~ ^r^vyix F -_____________________________ <br />_______^3 -p__SoapprvxZ_____________SUps <------------------------ <br />jg • . . ., <br />Jl.< jd$F- . , <br />■PS/j ia/ Q t pS l S r— <3< (20 l ->