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1 <br />SA-QcJo-WnCity: <br />5 <br /> <br />Item/Location <br />C\f-—\cj(c^y-x <br />Name:"F <br />Exp. Date:Warewashing Sink:ither:°F ppm <br />c -v <br />Chlorine: <br />Quat. Amm.: <br />Phone: <br />\ \^ArxV\ <br /> <br /> <br /> <br />I C -Vo ^32 I S <br />San Joaquin Col. y <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 />fc'-^v-^cA -Vo <br />------— <br /> <br /> <br />( Vv-cV),____________ <br />cpsxn) <br />/y- <br />j O | <br />-de <br />Pageyof^ <br />FOOD PROGRAM 0IR CONTINUATION <br />3 <br />X <br />S <br />Temperature <br />MM- <br />^8F <br />bl" <br />°F <br />Item / Location <br />dnAf •sA<^ <br />__l*MF I % <br />\ Gop_____ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br /><_ C ■ ■ . • '' x) <br />r\>P <Tl-s S'V'a_____________ <br />Received By/Ttleig^. & <br />EH Specialist: \ * V <br />Time in: -cr ' 7 /~x _______T> SQcxnx_______________ <br />EHD 16-24 (Z^pg) 4/3'13 <br />V\x>V S t <br />Ci) <br />Warewashing <br />ppm |Heat: <br />cas-o^o \\GF <br />-Ao VLoF <br />mJ) <br />M^>e>-0330 <br />TimeOut: '—7 \ <X <br />________________I 1 j'A_____________ <br />\w <br />Name of Facility: <br />Address: xqO _________________________________________________ <br />Owner/Operator: C/OS.S /A CpM____________________________ <br />Program Elemen^^program Record: / SOlp <br />SB180 Posted Yes No Permit Posted Yes No <br />Temperature <br />\si3F IT <br />Food Program Official Inspection Report______ <br />CrM__________________________Date: IQ-iS~I & <br />0>o/c/v<LO y Cit*: SA-odoX-n zipCode: °i S2o£ <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />cVsvJ tY-feXyN <br />CjPT—Cx Aa.I^ _______ <br />£ ■ - ■ '< '■ - ''-x-. <br />Food Safety Certification <br />jyx Vxy ul <br />py Vx. -V c-y-LkA <br />\ W) F / <br />y—S CxV