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Zip Code:City: <br />Telephone:Owner/Operator: <br />-o^CFtM <br />CAM <br />T <br />( HHK o <br />GP/H <br />CRM~OP <br />Cs)C RM <br />Lee PrV^LvJt^o"Lg; <br />TemperatureItem / LocationTemperature <br />Food Safety Certification <br />°FName:PPm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:F°F PPm <br />Phone: <br />Time Out:Time in: <br />EHD 16-24 (2wpg) 4/^13 <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 />Warewashing <br />Heat: <br />'4bg>~C>'*>3o <br />T----- <br />Chlorine: <br />PageNet. <br />FOOD PROGRAM 0IR CONTINUATION <br />Yes No <br />Program Element: y | 'c.F i < Pro9ram Record: <br />SB180 Posted Yes No Permit Posted <br />Received By/Title: <br />EH Specialist: JL-U , -> <br />______________Food Program Official Inspection Report_______ <br />Name of Facility: Rvy y Q F t L Date: <br />Address: <br />Inspection Type:Q j jL. <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />_________ <br />^O^C&Z. / (V-LLsxx - <br />Me Lor QP <br />Item/Location <br />\5J XxOCc <br />— <br />Facility Hot Water Temperature <br />Hand Sink: <br />CajJeXa- <br />YL) (A-aS p fX^Lo