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4 <br />City: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Item/Location Temperature I Item/Location <br />Food Safety Certification <br />Name:°F <br />Exp. Date:°FPPm <br />Phone:A <br />A' ; <br />£- <br />: No <br />^0*2 -fonriid <br />/rfx.% <br />Facility Hot Water Temperature <br />Hand Sink: op <br />JWarewashing Sink: <br />Warewashing <br />ppm ||Heat: <br />Other: <br />% <br />Chlorine: <br />op IQuat. Amm.: <br />(4) Imorll \przl - <br />tw\M^I Ts <br />- Ot<£ 0^ ' Window^ ’ a <br />_________________________________________________________________________ <br />-n^ of-va weaver <br />tanw prv teflle <br />iw <br />__________________ <br />___________Food Program Official Inspection Report______ <br />Name of Facility: ^^0^ Date: ~ <br />Address: *0^ fiftpOTV City: QhZMe^ Zip Code: <br />Owner/Operator: MCp6Any^|^> Te'ePhone:C||^32C^^O <br />Program Element: Program Record: V? Inspection Type:^^^ $2>M^>rtV~ <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />vJiTh tojor <br />are cyev - <br />ii'FO^^ <br />San Joaquin Co- y <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.org/ehd <br />SBK <br />'^oct-4fc^-2>44<g- <br />Time Out: Page^bf _ <br />FOOD PROGRAM 0IR CONTINUATION <br />Received By/Title: <br />EH Specialist: ~ <br />Time in: ( It <br />EHD 16-24 (2nd pg) 4/3/13 <br />vAl