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« I <br />Zip Code:City:____ <br />Telephone:Owner/Operator: <br />Inspection Type:Program Record:Program Element:___________ <br />Re-Inspection on or After:Permit Posted Yes NoYesNoSB180 Posted <br />— <br />// <br />n <br />/ <br />< I, ;. <br />& <br />A ■ <br />- % <br />Food Safety Certification <br />°FName:PPm <br />jOther:IQuat. Amm.:Warewashing Sink:°FExp. Date:F PPm <br />Received By/Title: <br />Phone:EH Specialist: <br />Page ofTime Out:Time in: <br />FOOD PROGRAM OIR CONTINUATION <br />]|_____ <br />Chlorine: <br />(Vi T c-/ <br />Warewashing <br />Heat: <br />/ 4'/- <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/ehd <br />----------- <br />9 XV, r(r <br />— <br />Name of Facility: <br />Address: <br />EHD 16-24 (2nd pg) 4/3/13 <br />—_______ <br />Temperature <br />1—~Temperature <br />< C a <br />< 1 ' ■ z' <br />zzc_ <br />Food Program Official Inspection Report <br />Date: e‘ //z, . <br />/)P) /a/C-z< . z-r - <br />/ /Zr<z z-z. <br />^-4 <br />z <br />Facility Hot Water Temperature <br />Hand Sink: <br />1^1 <br />----------Z- <br />OBSERVATIONS AND COR RECTI VE ACTIONS <br />ZT- <br />x- <br />"“I <br />y/, <br />_______ <br />''I.- ' " 15 __________ <br />^■7/*../ //O'r—ft ti---------------------------------------------------- <br />Item/Location <br />-a <br />_____ <br />(C«/zk l/\^ Ml <br />' <br />///-r <br />-ZZ— <br />_________ <br />__L <br />\Z3_ <br />Item / Location <br />; f e <br />z 7______ <br />AX 4; __ <br />?C ‘ <br />— <br />1-^ ■■/ - <br />--------’2’- -' <br />__( A he 1 <br />? >z.r <br />k^..^ <br />------a- <br />—Im—qX <br />'<'1 • <br />r.zZ:- <br />FV) VZhs x <br />__1^. <br />—u*X- <br />\ h'1 ■■