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City: <br />Scr-is'i / <br />s No <br />e- <br />6^ <br />(p / j <br />' TemperatureItem/Location <br />Food Safety Certification <br />°F <br />i Phone: <br />Page \ofTime Out: <br />FOOD PROGRAM OIR CONTINUATION <br />Name: <br />Exp. Date: <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.org/ehd <br />EH Specialist: <br />Time in: <br />°F <br />Facility Hot Water Temperature __________ <br />Hand Sink: <>F Chlorine: <br />Warewashing Sink: op Quat. Amm.:_____________ <br />O"*wl{C <br />< n <br />r ______________________ <br />- s-__ <br />< //^ _____________ <br />Temperature <br />Program Record: <br />Permit Posted Yes <br />I KI <br />!S NO <br />____<Vvc ~ <br />I <br />Item / Location <br />Food Program Official Inspection Report______ <br />Date: <clz7/27/ <br />hr<| £ C"y: T>XZLy ZlpCodei~ <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />Name of Facility: <br />Address:________LCK <br />Owner/Operator: <br />Program Element: I <br />SB180 Posted Yes <br />(T.) kOvMl^ _________ <br />CC</ l.-Akric flK <br />________nfA. If. <br />(/7»ygr <br />____Lio____ <br />------h A^/1 I [5 <br />----- i ^UZ 1 <br />—(^/_______—Armg/t <br />______\/\/VM a}1 '— <br />_____"I (20 <br />_______Crffb' <br />______ <br />Warewashing <br />ppm |He” <br />“TpmP^ <br />_^A0_------------ <br />/e^ <br />___________ <br />_________ <br />__________ <br />lReceived By/Ti,le: - A > A v <br />FflV'-xt >)^ c____Vt> ------------- <br />EHD 16-24 (2napg) 4/3/13 <br />£ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />/is S^z <br />_____I Vz^' A ____________________ <br />Z 0 I ~ O'/O/fsh <br />Ac./ <br />py_SlzU_§4!__ <br />$ --------------- <br />___ pic < ^///y / <br />( 2 /(i j _________ <br />- Sts <br />------^4?^—>