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City= <br />Temperature <br />EHD 16-24 (2'>apg) 4/3/13 <br />Chlorine: <br />Quat. Amm.: <br />Warewashing <br />PPm <br />ppm <br />San Joaquin Co. .ty <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 />Temperature <br />c <br />Name: <br />Exp. Date: ’ <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />°F <br />°F <br />====»========= <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />Heat: <br />Other: <br />Program Record: <br />Permit Posted Yes No <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Phone: <br />Time Out: <br />Food Program Official Inspection Report_______ <br />Aoa<Kviin Pate: <br />city: gpCode= q&Mfo <br />_____________________________Telephone:_________________ <br />Program Record: _____________Inspection Type: <br />“No Permit Posted Yes No Re-Inspection on or After: <br />4^9)" 4-^ <br />________________Pa9e -°t, - <br />FOOD PROGRAM OIR CONTINUATION <br />cHx- woq _ _________' <br /> <br />Item / Location <br />alc c\o not Wpg <br />-0^____________________________________________________ <br />-ya ytot ycLV^f2- rA ______ <br />-yfd ( W10W T7;nAUc/nrW-_________ <br />- i ncAT^Ai^nt irw VW capca _____ <br />Voir HlVm nob Cx frd Pl a she_____ <br />to (cvev ecl Vtxr.1 Cert <br />- I pir (odW of .4AF-- to Alt cn-wah) cx\\d cHx w, Wdq €W^t <br />~$gC4 OV^ AU J ' <br />11 '■*' Item/Location <br />. field Ice- <br />‘- L..... '... <br />Food Safety Certification <br />* OBSERVATIONS AND CORRECTIVE ACTIONS <br />"W—fio/ldfeQ'C \ILM'Ah _ __ _ ____ <br />- ytc ^CAn<tv^< fs ca\ W wm- fidySr _\oo i__- tfibs i dh W obaWru. <br />lo^y, vdodor TK^ <br />mrx!^ Aw wafimvq pjtw yWacW. W <br />A-JcpK cO CA W WLdW. v_________ <br />- Ofi _________