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I <br />City:Zip Code: <br />Owner/Operator:Telephone: <br />Program Element:Program Record:Inspection Type: <br />SB180 Posted Permit Posted Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />( <br />S <br />\OQ- <br />CYs <br />Food Safety Certification <br />Name:Heat: <br />Exp. Date:jWarewashing Sink:Quat. Amm.:Other:F ppm <br />Phone: <br />C <br />Warewashing <br />PPm <br />------ <br />San Joaquin Cou ■ <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 />FOOD PROGRAM OIR CONTINUATION <br />Name of Facility: t <br />Address: <br />Pcrx-k \ r <br />_VV^xdl2A F <br />Temperature <br />I F <br />Item / Location <br />___ <br />■■ <br />Chlorine:°F <br />°F <br />f <br />Temperature <br />izm i- <br />>51 l- <br />Facility Hot Water Temperature <br />Hand Sink: op <br />A-’ fT”? '^X <br />Item/Location <br />IcFuUan__ <br />H\ <br />Food Program Official Inspection Report <br />Date: <br />\^CV3 <br />Yes No <br />Time Out: <br />Received By / Title: ‘V LOML <br />EH Specialist: \ iF 1 <br />Timein: <br />EHD 16-24 (2nd pg) 4/3/13 <br />YsjFf _____________ <br />_E ~T<5\k t 3 O F -