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\ r<ACk <br />okcA <br />□±1 <br />\ <br />^1 VXo\e< <br />AL_C^ <br />Item / Location TemperatureItem/Location <br />SU2. <br />Food Safety Certification <br />:hlorine:Name:°F <br />luat. Amm.:ither:Warewashing Sink:Exp. Date:PPm <br />Phone: <br />EHD 16-24 (2napg) 4/3/13 <br />°F <br />Received By / \ I ( >L <br />EH Specialist: \ i » <br />_____ <br />Time in: <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 />As <br />\o <br />Temperature <br />-ASF <br />\ S F <br />°F <br />' 3>C) _____ <br />Time Out: Page,, ^f <br />FOOD PROGRAM 0IR CONTINUATION <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing <br />ppm ||Heat: <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element^ ^--Program Record: 2^\ / S kS O H Q) <br />SB180 Posted Yes No Permit Posted Yes No <br />\ VAj co <br />___;\UE___________ <br />—V-aVq ~ QQ ~~~ <br />Z/ <br />vS) A \ s PA <br />Q(e-p\6^ <br />FA CK-^ F SOg <br />~V~V) feA 'V <br />Food Program Official Inspection Report_______ <br />V x. Lc4________________Date: (o-lH-ZS <br />City:——/'rK Zip Code: <br />2^ Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />------------------