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City: <br /> <br /> X <br /> <br /> LCZ <br />c. <br />Temperature <br /> <br /> <br /> <br />Item / LocationTemperature <br /> <br />Item/Location <br />Food Safety Certification <br />FppmName: <br />Other:FExp. Date: <br />Page ofTime Out: <br />Warewashing <br />Heat: <br />San Joaquin County <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 /> <br />---1-7- 3 ‘ ______ <br />Name of Facility: <br />Address: <br />Chlorine: <br />w\ - <br />■ <br /> <br />Facility Hot Water Temperature <br />Hand Sink: °p <br />Warewashing Sink: °F Quat. Amm.: <br />; 1 ’ 1 / z <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />ppm <br /><90-1 b3“L S 7^3 <br />-3^ 2- <br />//. J;-/?//______ <br />FOOD PROGRAM 0IR CONTINUATION <br />Food Program Official Inspection Report <br />Da,e: <br />' Citv: TZ Zip Code: <br />Telephone: <br />— - inspection Type: <br />Re-Inspection on or After: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br /> <br />____U._ \^O Ir^LXcyl't^e /.QQ <br />________4-^7 t E3 —t—fVps/lk/^.— <br />C^o/Kj^ <3>1 z^?4 ■Af'Vr/.-^/-tT/ <br />(LM <br />NJ -----------nc-——- <br />ZZXx/) <br />Program Record:^ <br />No Permit Posted Yes No ' <br />Received ByTTItfe^ <br />EH Specialist: <br />Time In: <br />EHD 16-24 (2nd pg) 4/3/13 <br />—HS 10^- <br />___3 r___. I <br /> <br />r-----C2^ <br />J- SVzr'pS • <br />A/ <br />w: f