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Date: <br />Zip Code:LqcIa <br />Owner/Operator:Telephone: <br />Program Element:Inspection Type:- <br />SB180 Posted Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS ____ <br />UjO <br /><r>c <br />( <br />Item/Location Item / Location Temperature <br />Chlorine:Nai re:°FPPm <br />i. Di Warewashing Sink:Quat. Amm.:Other:.e:°F °Fppm <br />Received By / Title: <br />EH Specialist:Phone: <br />Time in: <br />Warewashing <br />Heat: <br />—Food Safety Certification <br />Name of Facility: <br />Address: j- <br />T Bi z. <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 />a <br />•_____ <br />' 106 <br />Pageysf <br />FOOD PROGRAM 0IR CONTINUATION <br />2^-15 <br />9 S 2,42 <br />Food Program Official Inspection Report <br />S-V\ \ jc-C. <br />City: <br />______________ <br /> Yes Hermit Posted <br />- ~ <br />Temperature <br />___________ <br />\Sl p <br />___ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />fy <br />Time Out: » . i -j,—<B C\y> <br />EHD 16-24 (2nd pg) 4/3/13 <br />Program Record: \ q U <br /> Yes I <br />BcA CV- <br />mo <br />Bap p <br />______V-UyV srvs<~J^>/\ <br />VkA <br />____________