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City: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Element: <br />Re-Inspection on or After:SB180 Posted Permit Posted <br />1V1 C__* <br />^Aor-e^,lV\ <br />J Temperature Item / Location TemperatureItem/Location <br />Food Safety Certification <br />Chlorine:Name:PPm <br />Warewashing Sink:Quat. Amm.:Other:Exp. Date:°FPPm <br />Received By/Title: <br />EH Specialist:Phone: <br />Time in:PageNet <br />FOOD PROGRAM OIR CONTINUATION <br />°F <br />Warewashing <br />Heat: <br />XU/' <br />s. <br />EHD 16-24 (2nd pg) 4/3/13 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />°F <br />IM'hT- <br />(\ ______________________ <br />Yes No <br />Time Out: . <br />Facility Hot Water Temperature <br />Hand Sink: op <br />I <br />Y) wo <br />San Joaquin Col / <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 />4-'’ <br />W: Rnilii luTrnQi- <br />- <br />•ViV\ C^k>A f oalx> <br />Food Program Official Inspection Report <br />---41^' lAat** M <br />HP W-V <br />OK___________ <br />dcr ^ J <br />Program Record: <br />Date: <br />ZipCode: <br />Name of Facility: C <br />Address: (to, <br />jtii <br />ILht <br />Yes No