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w: ra <br />VW?2I W? <br />5 No <br />4 <br />Food Safety Certification <br />Name: <br />Exp. Date: <br />Received By/Title: <br />EH Specialist: <br />Time in: <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 />Item/Location Temperature <br />°F <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />CA- loOpytn__ <br />|D& ----- <br />EHD 16-24 (2'“pg) 4/3/13 <br />Name of Facility: ( <br />Address: <br />Owner/Ope rator: Y <br />Program Element: \ <br />SB180 Posted Yes No <br />vX’tTv mvA- Q.An_l_DlL^(2tD___ <br /> <br /> -Hfe, <br /> <br /> <br /> i-flo nsHwt—' <br />n f) rVl <br />\ I ’ ’ f Item / Location j Temperature <br /> 4 wo tm -utceg <br /> <br /> <br /> Chlorine: ppm pat: <br />Quat. Amm.: ppm (Other: <br /> <br /> <br />Timeout: Page^of <br />FOOD PROGRAM OIR CONTINUATION <br />city: <br />Food Program Official Inspection Report <br />(Wt)0(AAfln thv/ku „ I Date: ~ <br />muWi U) J Clty: Imi Zlpcode: jUO <br />, m/UA'Kn SAC Telephone: <br />' Program Record: Inspection Type: p <br />No Permit Posted Yes No Re-Inspection on or After: • <br />OBSERVATIONS ANDCORRECTIVE ACTIONS <br /> <br /> <br /> <br /> <br /> (Q CoV Vt/Sio 63) SuIMUaW <br />irSy l ny (V-AvuvV Vy^Mv/flgVl <br /> \vWll)£'F <br /> ^PyWcU WdoW <br /> <br /> 4 WA HYWUs lb <br /> \r.4g_ cUX-ts