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* <br />i </r <br />City: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />yAgiad on Tt\g, <br />Temperature <br />Food Safety Certification <br />Chlorine: <br />Quat. Amm.: <br />Name: <br />Exp. Date: <br />ppm <br />PPm <br />Program Record: <br />Permit Posted <br />Warewashing <br />Heat: <br />Other: <br />C7C bv <br />°F <br />°F <br />. Wnacigc <br />(Cimbgc______ ___ <br />coot- -bmC-- ta€»a <br />A~t>c>oxj <br />iie CKesV <br />corcecAed. <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Received By / Title: <br />EH Specialist <br />Time in: <br />EHD 16-24 (2nd pg) 4/3/13 <br />San Joaquin Col y <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 />\ C • fid V <br />Pr°9ram Record: <br />No Permit Posted Yes No <br />Food Program Official Inspection Report______ <br />______________Date: <br />Zip Code: £^72 (Jk? <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />Qerno <br />- <br />(2? ltd', covihuni-M CoxVIeF- <br />____ <br />(g) liflKS CUb; . , <br />- The YteimW'ew pcrWusb Cbd M ocasMeinour kfc&eS. <br />' dog, tyd' VyavC a <br />TYxj&u YnV Vi <br />daezd bQCT cn <br />T b(kdCJKipS, <br />uPoArn - efeTd <br />Location Temperature <br /> ~ - 644c ~ <br />TimeOut: Page ^of^ <br />FOOD PROGRAM 0IR CONTINUATION <br />ins-ide. <br />- bdjxsT <br />/ * M gv lo^Hoac <br />t ______________ o-O min cw._______ <br />YyWC g os GterpoC.Ve Ler-y wvixx on yb. <br />"> -the <br />CEV tz; qq_cqntdi nc/f’S <br />C11 ofV The CFTAaM <br />Item / Location