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4; <br />Inspection Type: <br />Re-Inspection on or After: <br />_______ <br />st; 3 <br />CFi/vi <br />< / <br />k Eift A 4-WFA—<s~ <br />OF <br />Sl±l 7FA <br />< ¥ <br />J <br />Temperature J: /: : :Item / Location <br />Food Safety Certification <br />Name:Chlorine:PPm <br />Warewashing Sink:Quat. Amm.:Other:°F °FPPm <br />EH Specialist:Phone: <br />Page^pfTime in: <br />EHD 16-24 (2"a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />Time Out: <br />San Joaquin Count. <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 />fieat: <br />< mo <? yxfv-e <br />Temperature <br />Facility Hot Water Temperature <br />Hand Sink: op <br />\?p <br />°F <br />\O}, C <br />CV-Q/ <br />Food Program Official Inspection Report <br />Name of Facility: Gs/A-. TA/(V>ez" * 1 ~ <br />Address: A ~ V • (~> -> <br />________txiYXA/X A • V—X ./ ' TT"t <br />Owner/Operator: ’ <br />City: f) <br />Go M. <br />o <br />~^\O \Q____Y2 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />O\G_____________________ <br />-------------------------------------- <br />Exp. Date: <br />... ...... .... , .............. <br />Received By / Title: •i'"\ <br />——G <br />r-Q xy- <br />~1S. <tTem/Locatlon <br /><o-1 ~7-1 \o <br />zipc.d.; 0,5 3^ <br />Telephone: <br />Program Element- < Program Recoij: <br />SB180 Posted —/ □ yes □ Rermit Posted <br />~X tbs °g-J/