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City: <br />Telephone: <br />OK <br />\CVM ;er <br />okk )-'I <br />/)o< <br />o So. <br />d n <br />k) <br />Temperature Item / Location <br />( <br />Name:PPm <br />Exp. Date:Other:°FPPm <br />Phone: <br />Time in:Time Out:Page, of <br />(Chlorine: <br />Juat. Amm.: <br />JAAP <br />Item/Location <br />San Joaquin Col <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, GA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehcl <br />pr\)u <br />Warewashing <br />Heat: <br />Date: <br />Zip Code:°I3 2H <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />GFiM , <br />\cvaa7 <br />°F <br />v_) r\c o A~ <br />3) 4^-Ay <br />jsD p - sA\ \ \ <br />Food Safety Certification <br />S’oS'OSS’Q <br />FOOD PROGRAM 0IR CONTINUATION <br />JCa Q -_____ <br />JS4o \d 1 <5TJ pptVA <br />Temperature <br />Received By/Tide^^^. <br />EH Specialist: C^L J^VXc <br />EHD 16-24 (2ropg) 4/313 <br />’3-Wo l \TC> <br />Name of Facility: <br />Address: O <br />VQKJ- <br />Owner/Operator: <br />Food Program Official Inspection Report <br />/V\(7<zsJgX>^ <br />P CXr city' SrVxdcJ^AxfY^ <br />■>-A C <br />Program Eleme|Tt^^--, j^-P/ograrn Record: <br />SB180 Posted Yes No Permit Posted <br />I <br />S2^^r> lnspect'°nType:\2zxrVHs /Te <br />Yes No ' Re-Inspection on or After: <br />g^t)-4g;A^ k^sQ f—| <br />Facility Hot Water Temperature <br />BHand Sink: op |ci <br />IWarewashing Sink: op |iQ <br />' sT-erco-