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can <br />NoNo <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />15 > <br />QVA-M F.CW <br />cyn <br />Food Safety Certification <br />EHD 16-24 (2nd pg) 4/3/13 <br />Name: <br />Exp. Date: <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Chlorine: <br />Quat. Amm.: <br />Warewashing <br />Heat: <br />Other: <br />ppm <br />ppm <br />rqdp <br />°F <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Program Record: <br />Permit Posted Yes <br />San Joaquin Cc zty <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 />, n is V-CAvxq <br />gw yVokT <br />Food Program Official Inspection Report______ <br />-fcAmaU. Date: io/)4/P- <br />vT City: Zip Code: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />in <br />______An___- - meant' w O <br />a <br />g\Z c^z-n. until <br />ItardSAhfc \s <br />c5n <br />- \ rV \S> <br />Cad^T ccao <br />______ThG -ae/M p <5, g-y _____ <br />- 4FC "MV ________ <br />Jy dind Gv&giS <br />--Q J cha rra tyktotTckjvr wl wv yesrm\. Tnt <br />v<AV\ in Me mj^anVirrigT- <br />g-t Me jgtD I (x HocM <br />\^}C^ g L . • <br /> <br />Item/Location g f Temperature"! <br />cV(gvnz n <br />MF ___________ <br />\0J ■ <br />\N 10cOvd. <br />Phone: /iX06]-A-b‘b--?)44<=’ , , <br />Time Out: Page “?>f <br />FOOD PROGRAM OIR CONTINUATION <br />a floor . Y^cn W Q Fey/ <br />-pyenipg is rgriw’ <br />, _ _ w m to <br />d \HM LC fMacV . iG2z plqteol <br />M^lrrw'<^v <br />Item / Location | Temperature