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City: <br />4^ <br />a <br />K. <br />S <br />| Temperature <br />Food Safety Certification <br />fc/fe-3p?2.Xz-p'-z. <br />hlorine: <br />luat. Amm.: <br />PPm <br />PPm <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 />Name: <br />Exp. Date: <br />EH Specialist: <br />Time in: <br />Phone: <br />Time Out: <br />Warewashing <br />Heat: <br />Other: <br />Page | of <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />°F <br />- ^Oe ' <br />- <br />No <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes No <br />■ <br />Program Record: <br />Permit Posted Yes <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />7^/K ■ _________ <br />z i ~ ofc v'' <br />1'1*' <br />Food Program Official Inspection Report_______ <br />Date: //£rz>/ <br />£ LtM'J d___________City: led' ZipCode: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />1 <br />____(’Zcw d t-------------- <br />_______gr / dl <br />——C ----------- <br />______‘x- ~ Of?______________ <br />7^0 -d | <br />A^t/ nd <br />/I- dir <br />___ <br />Temperature <br />2- Mt ft ___~ C! ______ <br />- IfQ' <br />~ /$(______ <br />S- _:1\o. — <br />______C\j^d jt I_______ <br />______ <br />________p't <br />W ------- <br />----Q y------------ <br /><7 '"' '|GC_____________ <br />Facility Hot Water Temperature <br />Hand Sink: °F <br />Warewashing Sink: °F <br />Received By/Title: ■ <br />frosty <br />\\°r L| 5^ tXtAy <br />EHD 16-24 (2nd pg) 4/3/13 <br />[d' o <br />____(,.<d ~ fc^ ___________ <br />_____ <br />____/t yaJs. i <br />1' <br />Item / LocationItem/Location