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P.J Lcj I h 4Owner/Operator: <br />/ A fri i <br />AAi <br />£2i W i': 5 k <br />/ / J Ci a <:/ <br />■ Is Lc^/cr£_i n <br />J/ Uy>S e cC I J <br />Food Safety Certification <br />Chlorine:Name:°F <br />Warewashing Sink:Quat. Amm,:Exp. Date:°F°F ppm <br />Phone: <br />Time Out: <br />EHD 16-24 (2« pg) 4/3/13 <br />San Joaquin Coun. > <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqQV.org/ehd <br />JcicJCl <br />Ci <br />4, Ofl /&Ac <br />Name of Facility: <br />Address: <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />I'Ci r ;</l <br />City: <br />S' iioirl <br />No <br />1 f t/ftz J <br />n-l. Af y <br />^Cc -I <br />Lb' a <br />T <br />h <br />i zti t- 4/ <br />I Facility Hot Water Temperature <br />Hand Sink: op <br />/-^dcr <br />I r c.. Icr <br />5 7 • A <br />7 c- c/y <br />■ Temperature <br />___________^/z- <br />h n <br />rc (k r__ <br />I <br />I dc)c r <br />J - 6/ 0 c r <br />Program Element: <br />SB180 Posted Yes <br />?) cXe_ <br />(lcI Ciirc->^ <br />Item/Location <br />D.Hc Page of <br />FOOD PROGRAM 0IR CONTINUATION <br />V C/ <br />P*; ZA <br />J Temperature <br />7// <br />li n ppc - <br />1, / I y <br />Warewashing <br />ppm]^^ <br />(Other: <br />Inspection Type: <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />~ r V y/Z <br />fpct. h, v’5_________has jlifrtd________0 <br />| ili bf 15 . . ............1A__i-S____Afcl_» C: <br />c dc< cl ................hil. }Yy :'s.... <br />(jJ (j> f _______U g <br />Food Program Official Inspection Report <br />— T^c Date <br />Zip Code: Q j o <br />Telephone: <br />|4 o I ■ 5 <br />5 0 I_________Ci ry \ l\ l J <br />Rd j____|0:11 7 c ss<2 <br />(j £ ' Program Record: <br />No Permit Posted Yes <br />IS L.ZU.4/ <br />Pup^, Tf,,.//> <br />2..C...^L^..r.?...o..-l..J...y_......... <br />' - - .. <br />■y SU’Cl <br />__3.6E <br />)________¥ Cl I- d <br />(P r ; Jc <br />r ? C k 4. r/ <br />7^7 cd L H l, <br />u .V1., i 4 >__________R * ion «. x <br />I F Q r' <br />___ L <br />p u nr p . z~> <br />Item / Location <br />", rrirl^VQ-' <br />\) ct. I p In f I cJ 11 ii <br />,______“X-Jec r. 1/ l r <br />C ! aed.......................