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cr <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification <br /> <br />Name:Heat: <br />Exp. Date:Other:T FPPm <br />Phone: <br />- Q'r <br /> <br />Name of Facility: <br />Address: <br />Program Record: <br />Permit Posted <br />'Chlorine: <br />Quat. Amm.: <br />Warewashing <br />PPm <br />y ro st i de <br /> <br />°F <br />Time Out: Page^f <br />FOOD PROGRAM OIR CONTINUATION <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />-Nd <br />_________ OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ATc-rine. m <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 />- V06V <br />closed <br />___________ <br />_ I II <br />Facility Hot Water Temperature <br /> Hand Sink: Op <br />Warewashing Sink: <br />Received By / <br /> <br />EHD 16-24 (2'«pg) 4/3/13 <br />Hand waSlh ■ BcnUrra • <br />-> Cca/GC Thj2, incjcAjg <br />MC __ ________ <br />crp-OJ ’ipeexf’ dco/S and <br />Ho Ttve- vd'ie&d <br /> wn____: <br />IAJC1 (H GCllOl fa I <br />TTZTv'kdC o -tarp* -fZ> <br />-OIF <br />6p) Ti 4^ <br />-ho diSipgr&Cr fa tandwadni <br />- soy cad Feeds; havg <br />- VPcradg cVrV-<iiL&- 4£&V <br />_______________ __________________ ___________ <br />_(f) tcjrNfLlC2z> <br />____20fc_____________________________ <br />Food Program Official Inspection Report_______ <br />CVfcw Date: <br />yj . City: Q-POFtev Zip Code: <br />CcA-thX^n^ __________________Telephone: ___________ <br />][^C{Ly Program Record: [7 p.Inspection Type: p <2X <br />No Permit Posted Yes No Re-Inspection on or After: