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boy <br />Pro LA7 cLg ua-7 -ie <br />Prn <br />n^p <br />Food Safety Certification <br />Ivi 7c -I-7 <br />,£iafe <br /><?u63-7^/7 <br />^'0 <br />■ M <br />San Joaquin Couni <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 /><111) r -t r> -> <br />Item / Location <br />Name: <br />Exp. Date: <br />Received By / Titles <br />EH Specialist: <br />Time in: <br />Phone: <br />Time Out: <br />Chlorine: <br />Quat. Amm.: <br />Warewashing <br />ppm <br />PPm <br />Heat: <br />Other: <br />°F <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: oF <br />Warewashing Sink: op <br />1^175 <br />No <br />5) b O S 0 TZSaSZST <br />loo -10%L <br />__-p n 4__ <br />o -4 <br />12) 6^161 roi cvs <br />O^K <br />3) & (3 UJ <br />" lO ia Ac tt 4~z) <br />____o£ <br />- OrtJL A J a <br />Page of , <br />/ O <br />FOOD PROGRAM OIR CONTINUATION <br />Program Record: <br />Permit Posted Yes <br />Name of Facility: <br />Address: — . <br />___________<x tX / <br />Owner/Operator: 4 <br />Program Element: <br />SB180 Posted Yes <br />4a c/V d . Czt r <br />— t o °4- > TA € e /-> <4 O < <br />ks p-c >r --------------------------------- <br />La cK o4 - <br />Item/Location <br />(2) /At <br />/// <br />_____ <br />EHD 16-24 (2"apg) 4/3/13 <br />7A. GZ)0cA » <br />C® rr-f c^c_____ <br />I s Sov-e-e n ■ <br />Th <br />Temperature <br />rYi&j^ <br />(Ty uh s u ( ca 4-e <4 <br />~ O f •) AG / d 4% o d <br />—' > t i t -----r> O a \_4.—Li <br />-__T^ATyhc. ly, <br />m in Oo <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />^4 c\ v'O 4^ _______ <br />lat a 4~ i Q -q <br />CU^4< r <br />y p__Cj m.4-5, d-xz. O-tF _.4f_ozEr fr Id -fao-d— <br />r)S id 4>- rtyr ■CvirApAg.A -____________ <br />KS 6t_4- "R-T. Sh aU Lp I4> p4- <br />u <1_________ <br />r\ ^\>Jol3 Rd ^->z2 <br />^oo-io36F _______ <br />^>4'1 ; , ?"J . V c i'-* A.v <br />Temperature <br />______Food Program Official Inspection Report________ <br />FbS -F_________:________________Pate: -f<7 <br />A) Ctnlir' ________City: c4A/i ZipCode: <br />'OStinder" /Tbl'c-h^lLt..^_____Telephone.^qg3^35 <br />0 6 3^.5 37 inspection Type: <br />No Re-Inspection on or After: