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Telephone: <br />CtA.(T <br />Mcze^s^eLcz- <br />CH^ <br />TemperatureItem / Location <br />(Z\.r- <br />' r <br />Name:ppm <br />Other:Quat. Amm.:Warewashing Sink:°FExp. Date:°F PPm <br />/ <br />Phone: <br />Time Out:A <br />FOOD PROGRAM OIR CONTINUATION <br />Warewashing <br />Heat: <br />___ <br />°F <br />Program Record: <br />Permit Posted <br />Inspection Type: <br />Re-Inspection on or After: <br />_______ <br />Facility Hot Water Temperature <br />Hand Sink: »F Chlorine: <br />San Joaquin Couni <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 />5^0 <br />Yes No <br />U <br />EHD 16-24 (2nd pg) 4/3/13 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Ho-(~ Lt; <br />Temperature I s <br />■■■& <br />Item/Location <br />Food Safety Certification <br />) v <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes No <br />__€M _______ <br />r<. <br />____|OOppn^-^ I <br />x-u>Qr~/4) <br />_____________Food Program Official Inspection Report <br />Name of Facility: ^f r/Date: <br />Address: /Zlp Code: <br />^jrrx"' «: EOifi LOkL <br />zt.LV/y/ ,________ <br />B»celv./B,/Tlll^ j <br />EH Specialist: —T <br />Time in: <br />& —