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Item / Location <br />Food Safety Certification <br />o <br />EHD 16-24 (2«pg) 4/3/13 <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />IChlorine: <br />Quat. Amm.: <br />placed cm icg- <br />Warewashing <br />Heat: <br />Other: <br />ppm <br />ppm <br />°F <br />°F <br />FOOD PROGRAM OIR CONTINUATION <br />Phone: - <br />Time Out: <br />Facility Hot Water Temperature <br />Hand Sink: op" <br />_____ <br />Name: <br />Exp. Date: <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Wax) <br />i <br />No <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 />_________________________OBSERVATIONS AND CORRECTIVE ACTIONS <br />32 ' 7Z ZZ ZZ <br />- dr W <br />... ^32?- ~ i oD WjLeJ <br />63 <br />mzsasssizwoizz-&) W - <br />City: SWoMnV <br />6\) CoVe . <br />K qV oti -MZi <br />fzT ts3o rw- feUjdr feF)1r <br />13wv^V6u4- or Va3ca3 634^ bfi -fnsyy Cc)02 <br />j . , , , <br />- ¥6\\^ Firn 3 toincA c-fe^d <br />sdr Wil 2^ cfr QAj. 3 <br />Item/Location <br />Food Program Official Inspection Report________ <br />U?SW3 Date: <br />€». ftMFRjrt ______City: Stocx-VoV ZiPCode:q^2g^ <br />TelePh°neqjv?.„32o_6f743 <br />Program RecoTfc ^2. 2- Inspection Type:^^^ <br />Permit Posted Yes No Re-Inspection on or After: