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Sis <br />1 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />SVSr^-e, - <br />«> <br />X <br />^A\1 <sv <br /> <br /> 13V\ S t <br />-J.( 2 <br />I Temperature <br />I <br />t-' <br />°FName:PPm <br />Other:Quat. Amm.:Warewashing Sink:°FExp. Date:°F PPm <br />Chlorine: <br />Ptoq-zsmsB <br />_—xHr^/— <br />2_ c \'2^oP <br />gwa - UtScx Fa i <br />San Joaquin Cour <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 />P-Q <br />3SF <br />St r- <br />Temperature <br />I BGF <br />GV <br />T , 2 cVx <br />Facility Hot Water Temperature <br />Hand Sink: »p <br />V-/3JXYX W? <br />O vi-ii-x A-Vg CQOv <br />Food Safety Certification <br />e_ <br />-----C-CnAZ. <br />a^dat-- <br />- SCAcA <br />./^-er >- <br /><y fir ________________________ <br />PhPne: MbQ-OSSO <br />Timeout: °f | <br />FOOD PROGRAM 0IR CONTINUATION <br />Item I Location <br />r h h )___ <br />-,A <br />( V B F ) <br />Warewashing <br />Heat: <br />Food Program Official Inspection Report_______ <br />______Date: I2-I~1-I~7 <br />Zip Code: <br />Telephone: <br />inspection Type:^ <br />Re-Inspection on or After: <br />i7<\ -VVf ____________ <br />C'ty~ <br />Program'Record: <br />Permit Posted Yes <br />^£2^ <br />1 CTO F G Pr-\.(VA rycMrr j <br />S i C fi S <br />No <br />Item/Location <br />^2- cVx, Vqq/)o^ ~K p\< <br />2- Gy <br />2. S y ____ <br />&; Uk <br />\\:y-\Q\sjOO<^2X <br />Name of Facility: ; (G-yvp_ < G <br />Address: So\ <br />Owner/Operator: <br />Program Element: CT <br />SB180 Posted Yes No <br />Received By/Title: <br />EH Specialist: <br />Time in: <br />EHD 16-24 (2nd pg) 4/3/13 <br />- OK. <br />\ Ko^y <br />x/G\U Voe (Wy-y^J7 <br />VZx VY^ •___________