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OBSERVATIONS AND CORRECTIVE ACTIONS <br />( <br />I <br />Heat:Name:°FPPm <br />Other:Quat. Amm.:'arewashing Sink:Exp. Date:°F PPm <br />Phone: <br />Time Out: <br />^4^-2- <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.org/ehd <br />(AU <br />Page^of <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />No <br />Item/Location Temperature <br />str <br />3°lF <br />l°iOF <br />Temperature <br />401- <br />F-7-F <br />V <ro r c <br />Program Record: <br />Permit Posted Yes No <br />DC 7'^ <br />4 F <br />-------- <br />-Ac <br />T <br />Chlorine: <br />CkzA <br />Facility Hot Water Temperature <br />Hand Sink: ep <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />J QAdoF <br />yxA\-~T 1*0 <br />(g) - <br />AM <br />uAj - UA<O F <br />p.T->~v~v- <br />ctasap i <Q <br />(■\co &£ c <br />\V>J> \<y <br />SVC <br />CICq 33_EZ <br />Mt___________ <br />\ Aa ~* MO, <br />CD cAvAjbZzx C <br />Food Safety Certification <br />J . A. <br />'T- <br />Received By / Title: <br />EH Specialist: \ j <br />rlme'n: XUMstvA <br />EHD 16-24 (2-pg) 4/3/13 <br />MM <br />Item / Location <br />■ZcCy fL <br />2 cV^ C.-~ <br />_____________Food Program Official Inspection Report_____ <br />Name of Facility: i'L A I > \ C \ A ■, x V Dale: I O ~ 6 <br />Address: V City: ' Zip Code: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: