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No <br />\/\O <br /><z <br />Ly-■f <br />is (Ad-b <br />Ha <br />|wi <br />°F <br />Exp. Date:°F°F <br />Phone: <br />Page ofTime Out:Hua <br />FOOD PROGRAM OIR CONTINUATION <br />gtcEi <br />San Joaquin CoiOy <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orq/ehd <br />4* <br />jiL <br />> trrA <br />M\l~ <br />Warewashing <br />PPm <br />PPm <br />Heat: <br />Other: <br />l^T <br />I * F~ <br />i '5 <br />t____I/jiAe ________ <br />» <br />iLA <br />vtu <br />bjChlorine: <br />Quat. Amm.: <br />peM t>_____i~bv' <br />rkli -g-*T~~ <br />___________&2&C~ <br />______________________(XybWg-4 <br />I Temperature <br />“ •{7’^ <br />(cr^r <br />7 ~_________ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />'arewashing Sink: <br />Yes No <br />HIT <br />CcXrs < <br />4~~ cU>> <br />ck/4 <br />h jg. O— <br />C'ty <br />Temperature <br />tip <br />lot <br />-^£__ <br />Clc^ £ <br />Pivp/h i/VTM <br />aWW <> Z <br />V Program Record: <br />Permit Posted <br />Item / Location <br />tlA |\c>ia.lvV't<Av,u____________ <br />CJSw <br />frtfy 'L--iy- /Mx, <br />Received By/Title: <br />EH Specialist: ,/ <br />Time in: ^.00 <br />EHD 16-24 (2nd pg) 4/3/13 <br /><AfirX'l/YX <br />$ftzi <br />------ -------------------- <br />_____Lcwr i^A*- <br />jW <br />Cuuvkn Qh/i/ca/^oI <br />___ " CyA (<- > (( Vs17 b ( / <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />»^Uo C\;'xZ^f > - ( b'F bp. <br />mblaxhk* Vt^Ks Vzi^<e-.___ <br />m yi jc- <br />olfifegA, rtay? c4mmu^ <br />Vj (4 <br />Item/Location <br />(^) petvA VVT.-'G.y^nM__________ <br />Food Safety Certification <br />Name: <br />10 ?c? <br />h?VV<p<n^t<fvtAX -- //ut-ck^-s 'Ao_______ <br />(Zd C&vvk-df—5 <br />_____________Food Program Official Inspection Report <br />NameotFaolllt,; fevi^__________________________________DMe; <br />A<IJ,”S; |65» C ^'yfe-r OTfr C",: ^fe4v, , <br />Owner/Operator: a \n ~ J Telephone: <br />Program Element: <br />SB180 Posted Yes <br />Inspection Type:.^ <br />Re-Inspection on or After: