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IZ’. <br />City: <br />No <br />d-Ok?cAec r <br />-PxTZjX <br />IO^ r <br />*- >u8r- <br />Name:Chlorine:°FPPm <br />Exp. Date:Quat. Amm.:Other:°F °FPPm <br />Received By I Title: <br />Phone:(ot^o-SOZ^ <br />Time in:Time Out: <br />Warewashing <br />iHeat: <br />.Tv-e-x O I ^2 <br />C ____ <br />IQO <br />rx "vQ \ <br />3 bo <br />- E<vx <br />Temperature <br />HOF w <br />ml r <br />Oo<\ - <br />F - <br />F -aj<A-^-k5\ v ’E S - <br />EHD 16-24 (2"apg) 4/3/13 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />FF o yzs ^7 <br />L -VF o C - <br />fFo54OEZE <br />Warewashing Sink: <br />Page ^of <br />FOOD PROGRAM OIR CONTINUATION <br />■' O-.y7 F kOx 11 <br />Item I Location <br />skg^ozs <br />3D FF cl <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Temperature <br />3~7F <br />61)^0 <br />~ltem/Locatiori^ <br />OI cxrljV^-R._________ <br />Fc^YX ca__________________ <br />Food Safety Certification <br />> \ao- 1^3 r- <br />xj=) oq -FZ'V-p <br />■aO k\ K <br />\ Cg <br />Vd \ 0 0 <br />P lOO- IZ>3 F <br />4o I b> "S F- f C <br />C\ ' <br />(F3 <br />FnJ aw <br />VcWa C.^s c <br />San Joaquin County <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.orq/ehd <br />_ - wiwoy - <br />xsI^tv^Food Program Official Inspection Report_______ <br />Name of Facility: p, \ \ (5^4 cUl-Q^ Date: <br />Address: Zip Code: <br />Owner/Operator: FcTvZZvyJ , A3>\ \ \ F < Telephone: q F* | | <br />Program Element:_________________Program Record: / 5_____________________Inspection Type: / ~T ~ <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: '