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OBSERVATIONS AND CORRECTIVE ACTIONS <br />c <br />L <br />Food Safety Certification <br />Chlorine:Name:°FPPm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:°F°F PPm <br />Phone: <br />Page^of c—Time Out: <br />■ n <br />EHD 16-24 (2nd pg) 4/3/13 <br />Warewashing <br />Heat: <br />-5----------------\-----— <br />San Joaquin CoOty <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 />j: ic <br />' Item / Location"" | Temperature <br />Name of Facility: <br />Address: , <br />Received By/Title: <br />EH Specialist: <br />Time in: <br />$53. Z______ <br />Pa9y< <br />FOOD PROGRAM 0IR CONTINUATION <br />Facility Hot Water Temperature <br />Hand Sink: op <br />1 t "t~_ . <br />Temperature ] <br />’r-' IL__^_ <br />__ <br />AJekAi^ <br />.. , ,i4tv lihAk <br />i/rfjL Hgjudi. l+LtsL hiieni _________ <br />£5 033 ‘1325 <br />Yes No <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />■■■<■. , //. < ! <br />333^ ° <br />> No <br />I C l fX Ty <br />iIr <br />O€Vu <br />Cn'ko S <br />______Uuj L <br />—____A-/4 <br />— <br />_________$’ c&tfv__i <br />Item/Location <br />~ I'l ,(yi <br />3<r/hup <br />____LOO^>p ,K <br />---------------______£ t>£~i OJT <br />cAttfeew (Xvcd _ <br />-_____£vu— <br />3 n.'1 ——■» < 3 3 f~ “■ X <br />SlA l< ^LlpXt Vk << ------------- <br />t ( <- y'l vv 21 i ' ~efr 4 ^Z; ^5_____________ <br />—( <br />/kA ( Cc <br />ic l^rZ /C^ /P/Tvyv <br />Food Program Official Inspection Report______ <br />ic/.,,,/... iX/.. ■/ Date: <7Z//2Z¥ <br />7 7 dty: ZipCode: <br />> ' 1 / y / Telephone: <br />f £{ C______________________________________________________________ ________ <br />Program Record: Inspection Type: <br />Permit Posted Yes No Re-Inspection on or After: <br />0L4/u/ <br />tf-dpTvgziTftj__J ‘ <br />_ . ,_____ <br />__frli'iue.. <br />I fori# c£&/&y— <br />Y? <br />—'X, l -----C U LnV I v <br />LJ—Ur^-jz <br />.e. <br />cxvc'cl A& <br />i^TskU- <br />3 CgVyv bP <br />ZUnZL