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w: <br />Permit PostedSB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Temperature IT TemperatureItem / LocationItem/Location <br />Food Safety Certification <br />Name:Fppm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:Fppm <br />Phone: <br />Page^jfTime Out:Time in: <br />I____ <br />Chlorine: <br />Received By/Title: <br />EH Specialist-/^ <br />San Joaquin Coun'. <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 />iA. <br />Warewashing <br />Heat: <br />___________ <br />EHD 16-24 (2™) pg) 4/3/13 <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: op <br />_____________ <br />Yes No <br />1/■ ■'bo <br />FOOD PROGRAM 0IR CONTINUATION <br />Zip Code: <br />Inspection Type: O <br />Re-Inspection on or After: ' <br />_____________Food Program Official Inspection Report <br />Name of Facility: 1/ix.^y <br />Address: City: <br />Owner/Operator: <br />Program Element: i / Program Record: <br />Yes No