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I <br />4_ <br />$ tfii C/R <br />Temperature___ <br />■ - <br />■(S&Sgf <br />Phone: <br />Time Out:1^0 UM <br />EHD 16-24 (2™1pg) 4/3/13 <br />Program Record: <br />Permit Posted <br /> SE <br />16^ <br />No <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 />j>pm <br />ppm <br />°F <br />°F <br />Received By / Title, <br />EH Specialist: // <br />Time in: <br />Warewashing <br />HeatT <br />Other: <br />u____ <br />»iS <br />FOOD PROGRAM 0IR CONTINUATION <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />Facility Hot Water Temperature <br />Hand Sink: <br />Warewashing Sink: °F <br />Yes No <br />Temperature <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />it: JliM < I <br />vA I <br />,, — d •€>- <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />________ <br />Item/Location <br />.......... T-i/T //"TH// <br />Food Safety Certification <br />-45 _______________ <br />Item/Location <br />Pprh a hH^an <a) c <br />/< mo ^r: <br />__— ^6/- <br />----------- L) ________________---------------------- ----- <br />S'I LEE______NO tK7 <br />5 jo <br />—tVM(Lk <br />HAP___ <br />Co TtoH Cjfi(b-j toy <br />k/Oj io,T-r <br />________Mo I _ ' <br />p ^^2 <br />r-t+s- ' r <br />Food Program Official Inspection Report_______ <br />/"7A ^~7TT7,?i|. S.W-j <br />fO, 0g X__157-/h^JT^-Ar”7" <br />’ Telephone: <br />Inspection Type: BVeSJ T~ <br />Re-Inspection on or After: