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•x <br />AAtyg <br />r<9 <br />44 <br /> <br />Food Safety Certification <br />Page of <br />EHD 16-24 (2"apg) 4/3/13 FOOD PROGRAM OIR CONTINUATION3f <br />San Joaquin Counts <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 />Km* <br /> Item / Location <br />°F <br />°F <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted <br />Program Record: . Ct <br />O Yes Rermit Posted Yes I <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />Temperature <br />A <br />y <br />Food Program Official Inspection Report <br />^>CL "5r 4 U , <br />ZW <br />< n h i < <br />__ ref Q <br />ZZchiete^ <br />C-V <br />~ Date: Z///^ //j <br />Zip Code: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />-------T-T-------- j, Trov\ dJl <br /> <br />WVO [CZxVZ Pfavide,. AZ? <br />AJ/d 3>~TzhU^ - up 5 AV tdih <br />Irx c F • /w( (T? /SS <br />Item/Lo^tion Temperature | <br />Warewashing <br />ppm nHeat. <br />ppm |Other: <br />Phone: L|- b <br />Timeout: <br />pr2> v 1 (if ' <br />" m\A/ 1___ <br />AMU Rv,Zair<4-T\_5?rk C/tZckyvl F/^C n/z>T'V 44 F 2 <br />A;-hzCr~ /^>PS>KK f , < <br />RCF WeJ^XT1 f>^n?-JT _ <br />^/icitxujF <br />;if cMyC &Q- 4/ Zefat' o9<?l€_ <br />-ht Me / F. <br />___________________ _________ • <br />fiAZi& bzzie1 Ho-Z kx-Lr?luhc <br />_ X’xsx n I f xd A i <br />rreJc/ rhicUrtA <br />\_rrA <br />OBSERVATIONS AND CORRECTIVE ACTIONS