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City: <br />Telephone: <br />Yes No 'SB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Cr-i/vy <br />T <br />cA;c <br />(c <br />)) <br />) <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification <br />Name:FPPm <br />Exp. Date:Warewashing Sink:Other:°F PPm <br />Received By / Titles <br />EH Specialist:Phone: <br />Time in: <br />EHD 16-24 (2« pg) 4/3/13 <br />/ <br />2) <br />Ci <br />>L JC A <br />nJ <br />Facility Hot Water Temperature <br />IHand Sink: op iChlorine: <br />Quat. Amm.: <br />Warewashing <br />Heat: <br />Pag^of <br />FOOD PROGRAM OIR CONTINUATION <br />°F <br />V Q V C /A <br />Inspection Typeig^^x^y <br />Re-Inspection on or After: <br />A AgA <br />'SQgx_/7 CZy-x <br />-4-U? CvC4 <br />iTV tp/\5\/<ck.jQ CA <br />Food Program Official Inspection Report <br />fWvJcjL^' Date: <br />S^xsYlcAnA ZipCode:_________ <br />< W t 'Sa <br />C\ <br />Program Record: <br />Permit Posted <br />San Joaquin Cou r <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 />>-Vo$-03SO <br />Time Out: <br />Name of Facility: xJQaJI; ^\q-cQ. <br />Address:|?e^_oJ^A P\^ p. SA-^ <br />Owner/Operator: <br />Program Element:^^ <br />Yes No