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OBSERVATIONS AND CORRECTIVE ACTIONS <br />140^-Q-V <br />CiVSHcrnoSnr^. <br />CcrnecA^ <br />4^bAy. U C ^laceH <br />^rxJvogh fstafi cn4 is at KQf. M)usY <br />Temperature <br />Food Safety Certification <br />Phone: <br /> <br />Time Out: <br />Name: <br />Exp. Date: <br />PPm <br />Ppm <br />°F <br />°F <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 />Chlorine: <br />Quat. Amm.: <br />Warewashing <br />Heat: <br />Other: <br />(V '^l€ <br />-ttot <br /> Yes I <br />of lox/g > <br />wcner f^ <br />f7> - toer <br />arc) <br />- <br />NO <br />-0^ <br />Received By / Title: <br />EH Specialist: <br />Time in: fl | <br />EHD 16-24 (2nd pg) 4/3/13 <br />______________VAggt on The <br />-MtvsA Vk ____________ <br />wiski i~u sizAtoM not uv • <br />riHcAine Q-n^, ^nrvic^L <br />h'<nrig's crnVfgcd ________ <br />- oh cooled T 'avM Vries grC Qfr VCTJYA <br />on B - <br />-dV1 <br />Page f of <br />FOOD PROGRAM 0IR CONTINUATION <br />Q) UUkf T's <br />- rtp-F ftx <br />__________________________________________ <br />Item/Location ' Temperature Item / Location <br />@ Pei pcms <br />-ofc_____ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />_____________Food Program Official Inspection Report______ _ <br />Name of Facility: (Cf>rT^^ XlCltilgvl SpM PZ>C C C> T SfrOiV Date: iQ/tg/ljg, <br />Address: 2,0-\ n , C!ty: st&cvtW ZipCode: ~~ <br />Owner/Operator: SUMS ____________________________________________ _______________________________ <br />Program Element: | Program Record: I Inspection Type: p ,CzV^A'V <br />SB180 PostedII Yes Permit Posted Yes I Re-Inspection on or After: