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OBSERVATIONS AND CORRECTIVE ACTIONS <br />J <br />3> cxr,- <br />Item/Location <br />Food Safety Certification <br />Chlorine:Name:°Fppm <br />Exp. Date:Quat. Amm.:Other:°F °FPPm4 <br />Phone: <br /> <br />Time in: <br />City: <br />Warewashing <br />Heat: <br />Temperature i! <br />w <br />San Joaquin Counts <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 />co_____ <br />-R/V l-V\J <br />______________w r._. <br />| Facility Hot Water Temperature l| <br />Hand Sink: op <br />|WarewasNngJSink: <br />Name of Facility: <br />Address: <br />Received By / Title: <br />EH Specialists- <br />i kpo <br />on <br />k KJ, <br />C \ <br />J ICR- r <br />1 -T- ) C V Va <br />« <br />- Frj <br />~ Art V k ; S t- <br />t-----------— .1 Item/Location <br />(v|j <br />GsjxrtG. <br />//'"-a <br />iCSr ,?■ < <a G <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />Page^of <br />FOOD PROGRAM 0IR CONTINUATION <br />iSO <br />r________ <br />Owner/Operator: <br />Program Element: \ Program Record: <br />SB180 Posted Yes Rermit Posted Yes □! <br />'• "Crl&iCyTZF <br />G B <br />Temperature <br />V y-A <br />\<V, <br />EHD 16-24 (2nd pg) 4/3/13 <br />Food Program Official Inspection Report______ <br />______________________Date: <br />12 City: U3SU ZiP Code: <br />H b 9 < <br />Time Out: \ -n ’ xr r-\ ________* <- • <br />c^±_______________ <br />ooca 4 <br />\ AaYTjX. 0_q£l 4-x -