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Address: <br />Telephone: <br />A/bvvV- <br />A<y^ <br />Ae^ScfJ-v\ <br />ft?S. <br />4i\,r4izJbicL C'A <br />*xr<~ <br />- <y \^ <br />A ?- <br />S'KlWi If SS Sl^c4Vv, <br />n <br />" o v> <br />Temperature ]Item/Location _._ <br />Food Safety Certification <br />Chlorine:Name:°F <br />jWarewashing Sink:Quat. Amm.:°F°F ppm <br />Phone:EH Specialist: <br />Time in: <br />A:<p. <br />e> <br />San Joaquin Cou. . <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.orq/ehd <br />Ito'S <br />No <br />w> 51 <br />~)Unw\ <br />l.vW ft I <br />Inspection Type: <br />Re-Inspection on or After: <br />Warewashing <br />Heat: <br />a pTtVl <br /><Ce- <br />Page^of^ <br />FOOD PROGRAM 0IR CONTINUATIONEHD 16-24 (2nd pg) 4/3/13 <br />1. r? <br />___ <br />-0^ <br />-A <br />d A <br />Exp. Date: ' / <br />Received By/Title: <br />V-^-yz > <br />pl *4%;, <br />» AND CORREC <br />Mcs <br />Facility Hot Water Temperature <br />Hand Sink: op <br />GKahaaA A _ <br />OWKeJ- A <br />_____________Food Program Official Inspection Report <br />Name of Facility: Date: <br />I—-- ' ■ ,1. City; O-ti... Zip Code: <br />UU/ <br />5 gbiA <br />5 <br />.gjp'bfecJ <br />----! <br />)Mv V^) 4 ______ <br />fl . 5^ (jYTj4ztaw-> <br />Program Element: | <br />SB180 Posted Yes <br />- i5 foyAr <br />TemperatureItem / Location <br />v^'b^A <br />ovA /4-v4*|— <br />W, I <br />_______i <br />■ -dk___ <br />r«. w\ <br />sT^l-brs____Piik in <br />OBSERVATIONS <br />V^wx; \ iA/fi 5|vy^ <br />vyith___- <br />■ .~~b^y •' <br />TimeOut: <br />bS3> rt>» <br />Owner/Ope“ r-U.^ <br />fr^m Record: <br />Permit Posted Yes No <br />ppm <br />Other: ____