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City: <br />V), <br />ClCl <br />^>e>Q <br />w <br />/cos <br />CA^ ~J < i <br />Name:FPPm <br />Other:Quati Amm.:Warewashing Sink:Exp. Date:°FPPm <br />c <br />EHD 16-24 (2nd pg) 4/3/13 <br />VXjCv>7-V <br />\^-C F <br />\Cy^reJ-e^ <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.siqov.org/ehd <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Warewashing <br />Heat: <br />Page_^f <br />FOOD PROGRAM 0IR CONTINUATION <br />Temperature <br />V-VOF <br />Temperature <br />- i SS F <br />Food Safety Certification <br />\kfiS <br />No <br />SMO <br />No <br />V )Stf^ <br />\ V/vAcj \ Az?. <br />Facility Hot Water Temperature <br />Hand Sink: °p <br />I b b 1“ <br />) IOIqF <br />CZ> <br />Item/Location <br />OO C V~ <br />C <a3 t F <br />Item / Location____________ <br />V—r5 <br />______ <br />fcAVxZ-nj <br />Chlorine: <br />Time Out: <br />Program Record: <br />Permit Posted Yes <br />• ^0 (Y^r/'-T- V <br />tKV 4ex l0Mf=- <br />*^Vx'O <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />_F \ J!' X1. V^Xy- - <br />-r_k , <br />/ \q -j X-X-A \ kyO ^7 <br />(g> b< <br />@ p <br />_____________Food Program Official Inspection Report_____ <br />Name of Facility: \?y^V ~F Q-7X Date: M ~ ) ~l ft, <br />Address: \oMkW____________________________________________________________________________ <br />Owner/Operator: Telephone: <br />Program Element: y FjA S_____Program Record: 0) ______________________Inspection Type: ~y <br />SB180 Posted Yes No Permit Posted Yes No _ Re-Inspection on or After: